2012 New Hampshire Network Adequacy Report

The content of the New Hampshire Network Adequacy Report is based on the requirements of New Hampshire state insurance regulation Ins 2701.07 sections (g)(1) – (g)(11) and demonstrates Aetna’s compliance with New Hampshire network adequacy standards. The state regulation also requires insurance carriers to post this report on their website.

To request a paper copy of this report, please call the member services toll-free phone number on the back of your identification card.

2012 New Hampshire Network Adequacy Report

NH Ins. 2701.07 requirement Aetna response:
(b) The network adequacy report prepared by the health carrier shall describe and contain the following:  
(1) For each type of health benefit plan offered by the carrier, the current enrollment in this state in the form of a table setting forth the number of enrollees by county of residence and the total number of enrollees statewide;

See the Number of New Hampshire Enrollees By County and Benefit plan as of December 31st for the:

(2) A description of the network associated with each health benefit plan offered by the carrier, including a list of the network providers who are primary care providers, specialty care practitioners, and institutional providers by license, certification or specialty type and by county and hospital service area;

See the New Hampshire Network Providers (PCPs, specialists, pediatricians, OB/GYNs, REAP, hospitals, ancillaries) for the following plans:

(3) For each distinct network offered by the carrier, using a network accessibility analysis system such as GeoNetworks or any other system having similar capabilities, the following:

a. Maps showing the residential location of covered persons in New Hampshire, primary care providers, specialty care practitioners, and institutional providers; and

See the attached documents:

3b. An access table illustrating the relationship between providers and covered persons by county or hospital service area, and also on a statewide basis, including at a minimum:

1. The total number of covered persons;

See the attached reports:

2. The total number of primary care providers who are accepting new patients;

See (2) for the following reports:

  • PCP Status by County; and
  • Pediatricians Status by County
3. The total number of primary care providers who are not accepting new patients;

See (2) for the following reports:

  • PCP Status by County; and
  • Pediatricians Status by County
4. The percentage of covered persons meeting the primary care provider access standard in ins 2701.04 (b); See (3) b.1 NH Network Adequacy Analysis reports
5. The percentage of covered persons meeting the specialty care practitioner access standard in Ins 2701.04 (c) for each type of specialty care practitioner listed in Ins 2701.04 (c) (I); See (3) b.1 NH Network Adequacy Analysis reports
6. The total number of institutional providers and providers of certain other specialty services specified in Ins 2701.04 (d) by type; and See (3) b.1 NH Network Adequacy Analysis reports
7. The percentage of covered persons meeting the access standard for institutional providers and certain other specialty services in ins 2701.04 (d) See (3) b.1 NH Network Adequacy Analysis reports
(4) The health carrier’s procedures for making referrals within and outside its network;

See the policy attached:

HealthCare Professional Toolkit: Referral Policies (PDF, 30 KB)

(5) The health carrier’s process for monitoring and assuring on an ongoing basis the sufficiency of its network to meet the health care needs of persons who enroll in managed care plans; See the policy attached:

QM 10; Practitioner and Provider Availability: Network Composition and Contracting Plan (PDF, 62 KB)
(6) The health carrier’s plan for providing services in rural and underserved areas and for developing relationships with essential community providers; See (5) Policy QM 10 above
(7) The health carrier’s method of informing covered persons of the requirements and procedure; for gaining access to network providers, including but not limited to the following:

a, The process for choosing and changing network providers;
A member can select or change a network provider by consulting the How to Use this Directory section of the Aetna Provider Directory. The member may also call the toll-free Member Services number found on their ID card. In addition, members can log on to DocFind, Aetna's online provider directory, at www.aetna.com and select of change their Primary Care Physician at any time. Members can locate a participating physician based on geographical location, medical specialty and hospital affiliation.
b. The process for providing and approving emergency, urgent, and specialty care;

Members receive annual disclosures based on the type of network plan they are covered under describing the following:

  • Emergency and Urgent Care – No prior approval is required for emergency care.  Disclosures have an “Emergency and urgent care and care after office hours” section.
  • Specialty Care – Disclosures discuss the costs related to specialty care in or out of the network and whether a referral is required in the “Costs and rules for using your plan” section.
c. The identity of all of the plan’s participating providers and facilities, including a specification of those participating providers, if any, that are accessible only at a reduced benefit level; and There are no Aetna network providers who are only are accessible only at a reduced benefit level.
d. Whether and when referral options are restricted to less than all providers in the network who are qualified to provide covered specialty services. Referral options are not restricted to less than all providers in Aetna’s New Hampshire network service area. Members may be referred to all participating providers who provide covered specialty services.
(8) The health carrier’s system for ensuring the coordination of care for covered persons referred to specialty physicians, for covered persons using ancillary services, including Social services, behavioral health services and other community resources, and for ensuring appropriate discharge planning; For services subject to utilization review, Aetna identifies and refers members as appropriate for covered specialty programs as part of the precertification and concurrent review process. These programs include Aetna Health ConnectionsSM case management and disease management, behavioral health, National Medical Excellence Program®, and women’s health programs, such as the Beginning Right® Maternity Program and the infertility program. Members may also be identified for such programs based on certain diagnosis or treatment triggers. For inpatient stays, Aetna works with facility staff as needed to provide discharge planning assistance throughout the stay and to help coordinate covered services and supplies that are required after discharge.
(9) The health carrier’s process for enabling covered persons to change primary care providers; and A member can select or change a network provider by consulting the How to Use this Directory section of the Aetna Provider Directory. The member may also call the toll-free Member Services number found on their ID card. In addition, members can log on to DocFind, Aetna's online provider directory, at www.aetna.com and select of change their Primary Care Physician at any time. Members can locate a participating physician based on geographical location, medical specialty and hospital affiliation.
(10) The health carrier’s proposed plan for providing care in the event of contract termination between the health carrier and any of its participating providers, or in the event of the health carrier’s insolvency or other inability to continue operations.

See Provider Termination Narrative  (PDF, 13 KB)

Members who are in an active course of treatment with a participating provider when the provider’s contract terminates can ask Aetna to continue coverage with that provider at the plan’s in-network benefit level.  The member and provider would need to complete and submit a transition of care coverage request form (available from Member Services or the member’s employer) within 90 days of the provider’s contract termination date.   If approved, coverage at the in-network benefit level would continue for up to 90 days from the provider’s contract termination date or longer if needed for certain conditions or if required by state regulations.

(11) The description in b(10) shall explain how impacted covered persons will be notified of the contract termination, or the health carrier’s insolvency or other cessation of operations, and transferred to other providers in a timely manner. See policies for (10)
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