Idaho State Flexibility to Stabilize the Market Grant Award

Grant Application Summary

Idaho Grantee: Idaho Department of Insurance

Award Date: August 20, 2018

Total Award: $278,683.53

Baseline Award: $274,344.83

Workload Award: $4,338.70

Section 2702 - The Idaho Department of Insurance will acquire tools to measure network adequacy in an objective fashion, both at plan review and on an ongoing basis. These tools will reduce the reliance on insurer attestation, allow for greater knowledge and insight concerning networks, and ultimately provide greater consumer access to health care providers. In addition to ensuring health insurance issuers are offering approved products for purchase, Idaho will perform an assessment of what types of measurements need to be taken to determine network adequacy, and whether these measures will vary based on such factors as rural versus non-rural service areas, provider type, availability of transportation, or other criteria. The Idaho Department of Insurance is also seeking an assessment of which out-of-network providers are utilized by members of health plans utilizing networks, as well as the prevalence of balance billing for both emergency and non-emergency services. In addition, Idaho plans to develop a survey of covered members in order to measure the extent to which their health plan’s network is meeting their needs.