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Network Adequacy and Essential Community Providers Workgroup: A Report to the Maryland Health Benefit Exchange Board of Trustees

September 11, 2015

Network adequacy refers to a health plan’s ability to provide reasonable access to sufficient in-network providers. Essential community providers (ECPs) serve low-income and medically underserved populations and include such providers as federally qualified health centers (FQHCs), Ryan White designated providers, family planning clinics, Indian health providers, and specified hospitals. Pursuant to federal regulations, the Maryland Health Benefit Exchange (MHBE) is interested in further developing policies for ECPs and provider network adequacy. To achieve this goal, the MHBE tasked its Standing Advisory Committee (SAC) to create a Network Adequacy and ECP Workgroup (Workgroup), charged with reviewing background materials and developing and assessing various policy options for provider network standards. The Workgroup included 16 members, representing carriers, providers, and consumer advocacy organizations.
This report summarizes the background materials Hilltop developed for the Workgroup and the Workgroup’s discussions of policy options. The purpose of this report is to provide input to the MHBE Board of Trustees for the 2017 benefit year.

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