Network Adequacy Checklist
Network adequacy has traditionally focused on the ability of a health plan to provide enrollees with timely access to a sufficient number of in-network providers who provide health care services included in the benefit contract. Network adequacy, however, must consider standards of healthcare quality. Network adequacy must also be transparent so consumers can make informed decisions in choosing a health plan.
This checklist from Community Catalyst is designed to help consumer advocates examining network adequacy standards at the state level, given that network adequacy depends heavily on state environments and resources. It provides the ACA requirements and HHS aligned by five core principles—availability, accessibility, affordability, quality and transparency—and gives advocates key questions to consider when evaluating network adequacy.