Medicaid Managed Care Behavioral Health Network Adequacy: An OPEN MINDS Reference Guide
The adequacy of provider networks is an important measure of access to care for Medicaid beneficiaries. An adequate provider network can improve health outcomes by ensuring that enrollees receive care when it is needed. Measuring adequacy of provider networks is difficult for a multitude of reasons including difficulty deciding what measures best represent adequate access, testing adequacy, and ensuring that care is high quality. Currently state managed care programs have wide latitude in how they require health plans to measure network adequacy and do not have to utilize quantitative measures such as time and distance standards or clinical professional to member ratios.
This report provides an overview of the publicly available managed care network adequacy standards for behavioral health provider types to serve as a resource for current standards, an example of what future behavioral health network standards may look like, and as a comparison to the standards to be released after July 2018.