Cutler Institute for Health and Social Policy

Maine Rural Health Research Center, Population Health and Health Policy

Rural Considerations in Establishing Network Adequacy Standards for Qualified Health Plans in State and Regional Health Insurance Exchanges


The Affordable Care Act (ACA) requires Health Insurance Exchanges (HIEs) to specify network adequacy standards for the Qualified Health Plans (QHPs) they offer to consumers. This article, authored by research staff at the Maine Rural Health Research Center, USM Muskie School, examines rural issues surrounding network adequacy standards, and offers recommendations for crafting standards that optimize rural access.

The authors review ACA requirements for QHP network adequacy standards, considering Medicaid managed care and Medicare Advantage (MA) standards as models, and analyze the implications of stringent vs flexible access standards in terms of how choices might affect health plans' participation in rural markets and rural enrollees' access to care. The authors propose strategies for designing standards with the degree of flexibility most likely to benefit rural consumers, including adjusting standards according to degrees of rurality and rural utilization norms; counting midlevel clinicians toward fulfillment of patient-provider ratios; and allowing plans to ensure rural access through delivery system innovations such as telehealth.

Suggested Citation: Talbot, J. A., Coburn, A., Croll, Z. and Ziller, E. (2013), Rural Considerations in Establishing Network Adequacy Standards for Qualified Health Plans in State and Regional Health Insurance Exchanges. The Journal of Rural Health. doi: 10.1111/jrh.12012

Publication Type: 
Journal Article
Publish Date: 
February 22, 2013

Nellie Mae Education Foundation nominates Pious Ali for the Lawrence W. O'Toole Award

Pious Ali

Pious Ali, Youth and Community Engagement Specialist in Cutler’s Children, Youth, and Families Programs, has been nominated for the Lawrence W. O’Toole Award by the Nellie Mae Education Foundation. Pious is one of six nominees from the New England states.

The Nellie Mae Education Foundation believes that student-centered learning – where learning is personalized, engaging, competency-based and not restricted to the classroom – will prepare young people to graduate high school ready to contribute to their communities and succeed. This award is given out each year to an individual, school district, or non-profit that has exhibited great leadership in moving student-centered approaches to learning forward in the New England region.

The winner will be selected by online voting and will be awarded a $100,000 grant to help advance student centered learning!


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