Advocacy Update: TDI EPO/PPO Rule Adoption 04.10.24

Key Takeaways:

  • The adoption removed the proposed requirement to include additional information to show “good faith” in waiver requests, such as the percentage of Medicare offered and the average contracted rate in the geographic region.
  • The network adequacy portion defines a “sufficient” number of providers to mean two or more, which maintains previous state standards rather than aligning with federal standards. This also applies to “gap providers.”
  • The new network adequacy standards will apply to ‘24 filings, but the submission due date has been moved from April 1 to May 1. 
  • The adoption removes the proposed requirement to include plan documents in all advertisements, and instead requires them only on request.

Read the full advocacy update.

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