Proposed Scope of the Network Adequacy Study: Request for Public Comment; Notice 2022-11
[52 Pa.B. 3744]
[Saturday, July 2, 2022]
The Insurance Department (Department) has been awarded a total of $698,584 in Federal funds as a part of the State Flexibility to Stabilize the Market Grant Program Cycle II. One of the proposed projects includes studying the availability of providers in various specialties and geographic areas. 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 assess network adequacy considerations based on the findings. The development of this proposed list was informed by research on provider accessibility.
The Department welcomes public comment from organizations, consumer advocates, providers and consumers about their experience with getting an appointment or finding available specialists. The following is a proposed list of targeted provider types, but input, comments, lived experiences and suggestions of other provider types are needed. The final list for the study will include no more than ten provider types. When submitting responses individuals must 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.
Physical Health Specialists
Obstetrics and Gynecology
- Examples of services: gynecology services, annual exams, pap smears, prenatal care, post-partum care, sexually transmitted disease testing and treatment, breast exams, reproduction issues and cervical cancer treatment.
- Examples of services: diagnose and treat epilepsy, Multiple Sclerosis, Parkinson's Disease, Alzheimer's Disease, concussions, headaches and migraines, brain or spinal cord injury and stroke.
- Examples of services: cancer diagnosis and treatment.
- Examples of services: diagnose and treat skin conditions.
- Examples of services: mouth surgery, dental implants, extractions, dental infections, tooth repair, reconstructive oral surgery, jaw tumor or cyst removals, throat cancer treatment and facial injury repairs.
- Examples of services: diagnose and treat conditions pertaining to an individual's ear, nose and throat (also referred to as ear, nose and throat physicians).
- Examples of services: diagnose and treat gastrointestinal conditions, Irritable Bowel Syndrome, Hepatitis, peptic ulcers, Colitis, Pancreatitis and Gastroesophageal Reflux Disease.
Behavioral Health Specialists
Licensed Clinical Social Workers
Licensed Professional Counselors
Child and Adolescent Behavioral Analysts
- Examples of services: therapy, Intensive Behavioral Health Services, psychological testing, substance use disorder counseling and applied behavior analysis.
- Examples of services: diagnosis, prevention, study and treatment of mental disorders and prescribing psychotropic (mental health) medications (for example, medication for anxiety, depression, schizophrenia, bipolar disorder, eating disorders or addiction).
Addiction Medicine Physicians
- Examples of services: assess and treat substance use disorders (for example, alcohol use disorder or opioid use disorder) and prescribing medication assisted treatment.
Comments may be submitted to RA-IN-PolicyOffice@pa.gov, Attn: Katie Merritt, Policy Director, 1326 Strawberry Square, Harrisburg, PA 17120.
Comments will be accepted until Friday, August 5, 2022.
Acting Insurance Commissioner
[Pa.B. Doc. No. 22-989. Filed for public inspection July 1, 2022, 9:00 a.m.]
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