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Research, Peer Reviewed Scholarship 

Variation in Network Adequacy Standards in Medicaid Managed Care

Jun 9, 2022

Jane M. Zhu, MD, MPP, MSHP
Daniel Polsky, PhD, MPP
Cameron Johnstone, M
K. John McConnell, PhD

"One notable change, via the 2020 Medicaid managed care final rule, grants states more flexibility around the types of network adequacy standards used and the specific standards that are set. For example, the 2016 Medicaid managed care final rule required states to establish time and distance standards for 11 key types of providers.6 CMS recently removed the requirement that Medicaid programs use time and distance standards, instead allowing states to use any quantitative standard to define network adequacy. It is not yet clear what impact this policy change will have on the selection of network adequacy standards by states or on participation and compliance on the part of managed care organizations (MCOs). Nonetheless, it is likely that this policy will pertain to most Medicaid beneficiaries, at least 70% of whom are enrolled under managed care plans."

Colorado Medicaid Behavioral Health Provider Network

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