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Feds to look at Obamacare networks after Shea-Porter request

Staff Report
February 05. 2014 9:16PM

The U.S. Department of Health and Human Services has announced that the agency next year will require insurers to provide comprehensive lists of health care providers in their Obamacare networks, and will actively evaluate whether they provide reasonable access to hospitals, primary care doctors and other essential services.

The change in HHS procedures comes after U.S. Rep. Carol Shea-Porter, D-N.H., accused it of rubber-stamping the "narrow network" created by Anthem to serve New Hampshire residents who sign up through the online exchange at in New Hampshire. Anthem included only 16 of the state's 26 hospitals in the network, saying the designated hospitals demanded exclusivity in return for accepting lower rates of reimbursement.

Shea-Porter is also calling on Anthem to allow the state's Insurance Department to release the results of Anthem market research before a public hearing in Concord on Feb. 10.

The research, called a market conduct exam, evaluates the strength and adequacy of Anthem's network. HHS did not require a market conduct exam before it approved Anthem's narrow network last year, but the New Hampshire Insurance Department recently requested the exam.

Anthem spokesman Christopher R. Dugan said the New Hampshire Department of Insurance informed the company the preliminary market conduct exam had been completed.

"While we have not yet had the opportunity to review the report in detail, we fully respect the formal process and timeline set forth under the law for such reviews," Dugan said in a written statement Wednesday night.

"It's welcome news for Granite State families that HHS will improve its network adequacy oversight next year, but it doesn't change the fact that the public deserves answers this year to questions about Anthem's network adequacy," Shea-Porter said.

State officials learned late last year that Anthem would be the only insurer to offer products on the Obamacare website in the first year, and later learned that the network would exclude many of the state's hospitals.

Other insurers are expected to offer products on the Obamacare website in 2015, including Harvard-Pilgrim and Minuteman Health of Massachusetts.

In a Tuesday letter to insurance companies participating in the online marketplace, federal officials outlined the criteria by which the Centers for Medicare and Medicaid Services would evaluate future networks.

"To address limitations in provider contracting, issuers will need to provide substantial documentation of their contracting efforts in the geographic areas dropped, including lists of providers with whom the issuer attempted to contract and the contracts offered," read the letter.

Some of the hospitals left out of the Anthem network have complained that they were never even contacted.

Sen. Kelly Ayotte, a vocal opponent of Obamacare, said the controversy over narrow networks is another reflection of problems in the legislation.

"Our current situation in New Hampshire — where we only have one insurer participating on the exchange — is proof that Obamacare is a fundamentally flawed law that discourages competition," she said. "We need to scrap Obamacare, go back to the drawing board, and work in a bipartisan fashion to enact real health reforms that will allow greater competition and patient choice."

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