Regulation of provider networks in response to COVID-19

Am J Manag Care. 2021 Apr 1;27(4):e101-e104. doi: 10.37765/ajmc.2021.88614.


In public health insurance programs, federal and state regulators use network adequacy standards to ensure that health plans provide enrollees with adequate access to care. These standards are based on provider availability, anticipated enrollment, and patterns of care delivery. We anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. Regulators will need to ensure that plans adjust their network size should there be increased enrollment or increased utilization caused by forgone care. Regulators will also require updated monitoring data and plan network data that reflect postpandemic provider availability. Telehealth will have a larger role in care delivery than in the prepandemic period, and regulators will need to adapt network standards to accommodate in-person and virtual care delivery.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • COVID-19*
  • Health Insurance Exchanges
  • Health Planning*
  • Health Services Accessibility / standards*
  • Humans
  • Insurance Coverage / legislation & jurisprudence
  • Insurance Coverage / organization & administration
  • Insurance Coverage / standards*
  • Insurance, Health / legislation & jurisprudence
  • Insurance, Health / organization & administration
  • Insurance, Health / standards*
  • Medicaid / legislation & jurisprudence
  • Medicare / legislation & jurisprudence
  • Public Sector*
  • United States