Network Adequacy Resource Hub
At J2 Health, we understand that tracking the latest regulatory standards, templates, and deadlines can be cumbersome. To make things easier for your and your teams, we’ve assembled key resources that we’ve found helpful when submitting network for approval. We’d love to be a resource to your and your team!
PROVIDER SOURCES
(Updated July 20, 2023)
This downloadable file contains national provider data organized on the clinician/enrollment record/group/address level.
(Updated July 21, 2021)
This downloadable file contains a national directory of substance abuse and mental health providers & facilities.
- Health Guide USA’s Hospital and Health Facility License Look Up
(Links updated March 19, 2023 )
This pages contains list of links to state hospital and facility licensed directories that enables plans to look up and verify licensing attributes.
- National Provider & Plan Enumeration System (NPPES)
(Updated Daily)
This National provider database is maintained by CMS and is searchable by NPL, Provider Name, and Organization Name.
REGULATORY FILING CALENDAR
REGULATORY UPDATES
January 31, 2024
2025 Medicare Advantage and Part D Advance Notice Fact Sheet
January 9, 2024
2025 Part C Part D Application Release
November 15, 2023
HHS Notice of Benefit and Payment Parameters for 2025 Proposed Rule
November 8, 2023
Real Health Provider Act Passed the Senate Finance Committee (link to bill here)
April 5, 2023
CMS Medicare Advantage and Part D Final Rule 2024
FILING LINKS
Medicare Advantage
Medicare Advantage Network Adequacy Regulation
(Updated August 8,2023)
Title 42 Chapter IV Subchapter B Part 422 Subpart C § 422.116
Medicare Advantage Section 1876 Guidance File
(Updated August 30, 2022)
A Guide to Medicare Advantage Adequacy Specialty Requirements & Geo-Access Standards by County Type. Includes HSD Specialty Crosswalk & Partial County Justification Template.
Medicare Advantage Final Rule 2023
(Updated May 9, 2023)
The latest update to Medicare Advantage Standards which include a section more stringent requirements around Network Adequacy.
Division of Medicare Advantage Operations (DMAO) Question
Need help? Submit any questions you have direct to the DMAO using this handy form.
Filing Templates
Need filing help? Use our downloadable files to help with your work.
QHP
QHP Network Adequacy Regulation
Title 45 Subtitle A Subchapter B Part 156 Subpart C § 156.230
Fact sheet HHS Notice of Benefit and Payment Parameters for 2024 Final Rule (QHP)
(Updated April 17, 2023)
Network Adequacy updates include new ECP thresholds and the inclusion of Substance Use Disorder Treatment Centers and mental health facilities as ECP specialties.
QHP Final Letter to Issuers 2023
(Updated April 28, 2022)
Details on the QHP certification process that includes network adequacy time and distance tables.
Medicaid
Regulations vary on a state by state basis for Medicaid. If you have a need please reach out to [email protected] to learn more.
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Are we missing anything? We’d love to learn more about the resources you and your team find particularly helpful as you assemble your regulatory filings! Please share more here.