Governor Signs Legislation to Ensure Network Adequacy

Gov. Kemp recently signed the Consumer Access to Contracted Healthcare Act (CATCH Act), which amends the state’s Surprise Billing Consumer Protection Act to ensure participant access to quality healthcare by setting adequacy standards for network plans offered by an insurer and providing for telehealth services, among other items.

Specifically, the CATCH Act requires an insurer providing a network plan to contract with and maintain a network of participating providers in sufficient number and appropriate type, including primary care and specialty care, pharmacies, clinical laboratories and facilities, throughout such plan's service area to ensure covered persons have access to the full scope of benefits and services covered under such plan.

Similarly, an insurer providing coverage for mental health or substance use disorders as part of a network plan shall contract with and maintain a network of participating providers that specialize in mental health and substance use disorder services in sufficient number and appropriate type throughout such plan's service area to ensure covered persons have access to the full scope of mental health and substance use disorder benefits and services covered under such plan.

Additionally, the CATCH Act provides numerous protections for telehealth services. For example, insurers are prohibited from requiring prior authorization, medical review or administrative clearance for a telehealth service that would not be required if such service were provided in person. Insurers also must not deny coverage of a telehealth service based solely on the communication technology or application used to deliver such service.

Beginning January 1, 2025, and annually thereafter, insurers will be required to report data to show compliance with the CATCH Act. Although the new provisions are primarily directed at insurers, employers that sponsor insured group health plans may want to be aware of the requirements.

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