Annual Network Adequacy

Medicare Advantage Standard

• Med Advantage 2018-Network-Adequacy-Guidance
• Med Advantage HSD CY2019 Reference File (OR only)2019 Reference
• Any Carrier using the Medicare Advantage standard to show evidence of compliance will be required to include Pediatrics as a specialty type in document provided directly above. Geriatrics may be removed as a specialty type.

QHP Standard

• Qualified Health Plan Issuer Application Instructions - Plan Year 2025 - Extracted Appendix E: Network Adequacy Standards
• QHP network adequacy requirements begin on page 24 of the CMS 2018 Letter to Issuers in the Federally-facilitated Marketplaces, link provided. Addendum to 2018 Letter to Issuers in the Federally-facilitated Marketplaces
• 2017 QHP network adequacy requirements (OR only)

Annual Network Adequacy Report – Reporting Guidelines. These guidelines outline what the Division would like to see in the narrative responses from insurers. If the insurers report does not include information from the Guidelines the Division may reach out to the insurer for clarification. Insurers may submit the report through SERFF, the Division’s electronic filing system.

CMS Low-Income Zip Code List. This list is used for reporting low-income zip codes per Bulletin No. DFR 2026-3. Carriers must use list to complete annual network adequacy reporting.