California was the first state in the nation to pass legislation creating a health insurance exchange, known as Covered California, after the enactment of the federal Patient Protection and Affordable Care Act (ACA). The state continues to consider legislation implementing the ACA.
CRA tracks proposed legislation and regulation implementing the ACA of impact the rheumatic community.
Most recently, CRA wrote Governor Brown in support of legislation (SB 964) to ensure network adequacy. The ACA requires qualified health plans to maintain adequate provider networks. Yet, a recent analysis of exchange plans nationwide shows approximately 40% of plan networks were classified as ultranarrow or narrow. Within the state, Medi-Cal and Covered California offer narrow provider networks, limiting access to health care providers, including rheumatologists. Covered California has reported questions of provider directory accuracy, timely access, physician confusion regarding network status, and benefit design uncertainty. California must ensure that narrow networks are adequate and provide timely access to quality care.
As such, CRA supports the enactment of SB 964, requiring Department of Managed Care (DMHC) surveys for timely access and network adequacy be done separately and more frequently for Medi-Cal managed care and Covered California to ensure network adequacy for enrollees.