AMA Urges New Standards For Health Plan Network Adequacy

Concern remains that patients’ health care needs are not being met by health plans that offer inadequate networks of physicians, clinicians, and facilities. To facilitate patient choice and promote adequate access to timely, convenient, quality care, physician and medical student members of the AMA House of Delegates voted to adopt AMA policy supporting establishment and enforcement of standard to strengthen network adequacy.

Inadequate networks create obstacles for patients seeking new or continued care and limit their choice of physicians and facilities. Strong regulatory oversight is needed to ensure health plans do not inappropriately limit patient access to in-network care. Due to state variability in network adequacy oversight, the AMA will work to establish and enforce a minimum network adequacy standard for health plans.

“The AMA believes regulators must do better to ensure network adequacy to ensure patients have options in accessing care,” said AMA President Jesse M. Ehrenfeld, M.D., M.P.H. “The policy adopted today will help the AMA encourage a multilayered approach for regulatory oversite that includes meaningful standards, transparency of network breadth, parameters for out-of-network care, and effective monitoring and enforcement of existing standards.”

The new policy strengthens the AMA’s continued work to ensure patients have access to adequate networks of care and to hold health plans accountable for networks that are too narrow.