With regard to the laws and regulations on access and adequacy of provider networks, it can correctly be stated that:
A) most access and adequacy guidelines relate to preferred provider organizations (PPOs) or managed indemnity products
B) corporate practice of medicine laws require staff model HMOs to hire physicians directly, even if the physicians do not own the HMO
C) any willing provider laws prevent a health plan from making exclusive or semi-exclusive arrangements with a provider or a group of providers
D) the NAIC Managed Care Plan Network Adequacy Model Act requires states to use provider- enrollee ratios as the sole measure of network adequacy

Question

Quizplus · Accepted Answer

Any willing provider laws prevent a health plan from making exclusive or semi-exclusive arrangements with a provider or a group of providers. Access and adequacy guidelines apply to all types of managed care plans, not just PPOs or managed indemnity products. Corporate practice of medicine laws vary by state and do not necessarily require staff model HMOs to hire physicians directly. The NAIC Managed Care Plan Network Adequacy Model Act suggests that states use provider-enrollee ratios as one of several measures of network adequacy, not the sole measure.

With Regard to the Laws and Regulations on Access and Adequacy