PPOS: Only 13 States Currently Regulate
The number of Americans enrolled in PPOs jumped 5% last year to 100 million -- making them the most popular form of health plan - - but to date lawmakers in only thirteen states have enacted broad regulations to ensure quality of care in PPOs, according to a new survey from the American Accreditation HealthCare Commission/URAC. Five areas of quality oversight -- utilization review, provider network management and participation, provider credentialing, quality management and member protection and participation -- are all subject to regulation in Delaware, Georgia, Illinois, Kentucky, Nebraska, New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island and Virginia. The survey also found that:
- 12 states require PPOs to credential their participating health care providers;
- 15 require PPOs to have a quality management program;
- 18 require PPOs to have a member grievance and appeals procedure;
- 9 require that health care providers be involved in network management activities;
- 12 require special licensure or registration of PPOS;
- 25 impose at least some minimal requirement on PPOs to allow reasonable access to providers.