Network adequacy remains a significant challenge for behavioral healthcare in Medicare Advantage (MA) and Medicaid managed care, according to a new report.
Analysts at the Department of Health and Human Services' Office of Inspector General (OIG) examined behavioral health networks across MA and Medicaid, finding that many plans' networks in this space were limited.
This trend is exacerbated by the fact that, in many cases, the providers listed as being in-network are inactive. The OIG analysis found that 72% of the inactive providers included should not have been listed in the insurer's network; for example, because there isn't anyone working at locations listed for the provider or the provider indicated they would not treat patients enrolled in a certain plan.
These so-called "ghost networks" have gotten insurers in hot water, with lawsuits challenging multiple payers over the issue.
The OIG said in the report that payers may list inactive providers in a bid to "make the networks appear larger than they are." In an earlier analysis, the OIG found that there were fewer than five active behavioral health providers available per 1,000 enrollees across traditional Medicare, MA and Medicaid managed care.
"The breadth of a plan’s network is typically measured by comparing the total workforce of providers in a given area to the number of providers who contract with a plan," per the report. "When a plan has a limited provider network, enrollees may face challenges finding care."
The OIG offered several recommendations to the Centers for Medicare & Medicaid Services (CMS) that could help address the issues around ghost networks. For one, the agency recommends the CMS do more with data to track network accuracy and provider directories in MA.
The CMS can also work more closely with states to drive improvements in network adequacy for Medicaid as well as continue investigating whether a national directory could mitigate these inaccuracies and improve administrative efficiency for both providers and patients.
The report says the CMS did not weigh in specifically on whether it agrees with these suggestions but suggested it has already taken some steps in this arena and is planning further efforts in the future.