PPOS: Only 13 States Currently Regulate

The number of Americans enrolled in PPOs jumped 5% last year to 100 million -- making them the most popular form of health plan - - but to date lawmakers in only thirteen states have enacted broad regulations to ensure quality of care in PPOs, according to a new survey from the American Accreditation HealthCare Commission/URAC. Five areas of quality oversight -- utilization review, provider network management and participation, provider credentialing, quality management and member protection and participation -- are all subject to regulation in Delaware, Georgia, Illinois, Kentucky, Nebraska, New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island and Virginia. The survey also found that:

12 states require PPOs to credential their participating health care providers;
15 require PPOs to have a quality management program;
18 require PPOs to have a member grievance and appeals procedure;
9 require that health care providers be involved in network management activities;
12 require special licensure or registration of PPOS;
25 impose at least some minimal requirement on PPOs to allow reasonable access to providers.

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