Network adequacy requirements exist to protect insured patients. What do these requirements actually mandate?

Network adequacy standards, enforced by the Centers for Medicare and Medicaid Services and state insurance regulators, set minimum requirements for how many providers — by specialty type — must be available to plan members within specified distance and time standards. For example, a plan might be required to have a primary care physician available within 15 miles or 30 minutes for urban members. These standards exist because an insurance plan is effectively useless if it covers services but has no available providers to deliver them. Network adequacy enforcement has been a persistent challenge, particularly for mental health providers and specialists in rural areas.