Dive Brief:
- If approved, a new federal proposal requiring ACA health exchange plans to expand provider networks would have a positive effect on nonprofit hospitals treating high volumes of low-income patients.
- Growing numbers of narrow networks have been bad for nonprofit hospitals, as hospitals in the networks end up accepting lower reimbursement. Meanwhile, nonprofits left out of the networks face losing market share.
- However, new CMS guidance for 2015 would prevent this, as it would require that health plan provider networks under the ACA contain sufficient numbers and types of providers, notes Moody's Investors Service.
Dive Insight:
If CMS's proposed 2015 certification requirements for qualified health marketplace plans go through, it would be especially good for safety net hospitals, as the proposal specifically calls for their inclusion in networks. But it would be a plus for all nonprofits that have high exposure to Medicaid and treat large numbers of low-income patients, Moody's says. So...the insurance industry pushes narrow networks, and CMS pushes back. Who do you think is going to win that scuffle?