Our AMA will:

(1) seek to have third party payers disclose, in plain language, the criteria by which the carrier creates a tiered, narrow or restricted network;

(2) monitor the development of tiered, narrow or restricted networks to ensure that they are not inappropriately driven by economic criteria by the plans and that patients are not caused health care access problems based on the potential for a limited number of specialists in the resulting network(s); and

(3) seek legislation or regulation which prohibits the formation of networks based solely on economic criteria and ensures that, before health plans can establish new panel networks, physicians are informed of the criteria for participating in those networks, with sufficient advance time to permit them to satisfy the criteria.

Policy Timeline

Res. 806, I-06 Reaffirmed in lieu of Res. 729, A-08 Reaffirmation I-10 Reaffirmed in lieu of Res. 815, I-13 Reaffirmation A-14 Reaffirmed: CMS Rep. 4, I-14 Reaffirmation I-15