Harrisburg, PA – Pennsylvania Acting Insurance Commissioner Michael Humphreys today announced a network adequacy study as part of the State Flexibility to Stabilize the Market Grant Program Cycle II provided by the Centers for Medicare & Medicaid Services (CMS). One of the proposed projects includes studying accessibility of medical providers throughout the Commonwealth, particularly specialty providers.
The goal of this study is to understand areas of need based on current availability of providers to accept new patients, the amount of time it takes to get an appointment with these providers and to help assess if the state's current healthcare network can adequately address the needs of the population. The department welcomes public comment from organizations, consumer advocates, providers, and consumers about their experience with accessing various in-network providers.
"There is a reasonable expectation that consumers have access to in-network providers within an adequate network," said Acting Commissioner Humphreys. "CMS has focused federal attention towards network adequacy. Using this CMS grant, and inviting public comment to inform our work, will allow us an opportunity to further study commercial networks in Pennsylvania to identify any gaps or areas of need within certain medical specialties."
Pennsylvanians want and deserve access to comprehensive health coverage and should expect to be able to see a specialist within a reasonable distance from their home without waiting for months. The Wolf administration recognizes this and continues the ongoing commitment to protect and educate consumers while fostering a competitive market. This public comment period provides an opportunity for Pennsylvanians to tell the department where their needs are that are not currently being addressed.
The department has developed a list of targeted provider areas, but strongly welcomes input, comments, lived experiences and suggestions of other provider types and areas of need. The final list for the study will include no more than ten provider types. When submitting responses, the department is requesting individuals indicate which of the following provider types they believe have accessibility issues based on their experiences or known issues or if they have experienced access issues with provider types that are not included on the list.
Current Targeted Provider Areas:
- Physical Health Specialists
- Obstetrics and Gynecology
- Oral Surgeons
- Behavioral Health Specialists
- Licensed Clinical Social Workers
- Licensed Professional Counselors
- Child and Adolescent Behavioral Analysts
- Addiction Medicine Physicians
Comments from Pennsylvanians may be submitted by email to RA-IN-PolicyOffice@pa.gov. Comments can also be submitted via mail, Attn: Katie Merritt, Policy Director, 1326 Strawberry Square, Harrisburg, PA 17120.
Comments will be accepted until Friday, August 5, 2022.
For more information and examples, review the department's Pennsylvania Bulletin notice here.