The letter includes proposed 2015 certification requirements for qualified health plans offered through the marketplace and SHOP. For instance, qualified health plans with provider networks must have networks containing sufficient numbers and types of providers. CMS intends to propose that qualified health plan provider networks include at least 30 percent of available essential community providers, up from 20 percent in 2014. Essential community providers are those that serve predominantly low-income and medically underserved individuals, according to CMS.
For more information on the proposed 2015 certification requirements, read the full letter here. CMS will accept comments on selected elements of the draft letter, including the provider network requirements, through Feb. 25.
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