Key Implementation Dates & Deadlines
- Pursuant to section 4709, the provisions of this rulemaking apply to plans sold, issued, or renewed on or after January 1, 2024.
- Pursuant to sections 4702.2 and 4703.1, the first Network Adequacy Report (“Report”) and the first Access Plan were each due September 1, 2023 and are to reflect those plans to be sold, issued, or renewed on or after January 1, 2024.
- It is the intent to have a Report be filed annually on or by September 1, whereas subsequent Access Plans are only filed in the event there is a new or amended network plan (4703.1) and/or a material change to its network plan (4703.2).
- Any other requirements specified in the rule (for example hold harmless provisions at 4704.3 & provider contract requirements at 4704.21) must also be reflected in plans and plan filings no later than September 1, 2023. However, the Department will offer an exception for group health plans: since group health plans may be sold, issued, or renewed on a rolling basis, any adjustments to form filings may be submitted to DISB no later than two months prior to their effective date (for example a health plan that will renew for a large group on February 1, 2024 will need to be filed with DISB no later than December 1, 2023).
- New for 2024:
- The call center activities regarding Appointment Wait Times at 4702.5(d) and 4702.6(d).
- The list of requests to access covered benefits from non-participating providers at 4702.8(d).
- The log regarding provider directory inaccuracies under 4705.5.
Provider Accessibility
- Pursuant to 4702.5(c) and 4702.6(c), the Commissioner hereby releases the list of providers with an office located within half (1/2) of a mile of a Metrorail stop: (password to be sent via email, along with a Network Adequacy reporting template/checklist) https://app.box.com/s/wy8d97rvt537j6rb0ilxwp6o12w9cita
Information to be Included in the Access Plan
- The information referred to in 4703.3; and 4702.2 if/when applicable in future years.
Contact
If you have any questions or concerns regarding this notice, please contact Howard Liebers, Supervisory Insurance Examiner, at [email protected] or Pratima Lele,Market Compliance Examinations Manager, at [email protected]
