Network adequacy and behavioral health insights for health plan leaders.
Practical guidance for network executives on meeting CMS and state Medicaid access requirements, closing gaps, and building behavioral health capacity.
Network Adequacy for Health Plans
CMS time and distance analysis, HSD table preparation, gap closure, service area expansion, and Medicaid managed care readiness for health plan network leaders.
Behavioral Health Network Development
Building, credentialing, and leasing behavioral health provider networks that help plans close access gaps in psychiatry, psychology, and clinical social work.
Network Adequacy for Health Plans
Explore network adequacy servicesCMS Time and Distance Standards: What Medicare Advantage Network Leaders Need to Measure
Provider counts don't pass a CMS review. Beneficiary access does. Here is how the time and distance test actually works, county by county and specialty by specialty.
Preparing Provider and Facility HSD Tables Without Late-Stage Surprises
Most HSD problems are data problems that show up on deadline week. A disciplined preparation process catches them while there is still time to fix the network.
Closing Network Adequacy Gaps With Targeted Non-Par Provider Contracting
Broad recruiting campaigns spend months and contracting budget on providers who don't move the access percentage. Targeted gap closure starts with which provider, in which ZIP code, changes the result.
Medicare Advantage Service Area Expansion: Test County Feasibility Before You File
Since contract year 2024, network adequacy is part of the expansion application, and CMS can deny on it. Feasibility testing belongs at the start of expansion planning, not the end.
The CMS Telehealth Credit: How to Use It Without Overrelying on It
The telehealth credit can lift a specialty over the threshold. It cannot rescue a network that is far short, and it doesn't replace in-person access members still need.
Network Adequacy Exception Requests: When to File and When to Keep Recruiting
An exception is a request for CMS to recognize that a market can't support the standard. It works when the evidence is real, and fails when it looks like the plan simply stopped recruiting.
Medicaid Managed Care Network Adequacy After the 2024 Access Rule
The 2024 Medicaid managed care rule moves adequacy beyond time and distance to whether members can actually get an appointment. Plans that prepare early will be measured on a network that's ready.
Medicaid RFP Network Readiness: Build a Defensible Network Before Procurement
In a Medicaid procurement, the network is part of the scored response. Plans that build it before the RFP drops compete on strength; plans that build after compete on promises.
Behavioral Health Network Development
Explore behavioral health networksBehavioral Health Network Gaps in Medicare Advantage: Psychiatry, Psychology, and Social Work
CMS now evaluates Clinical Psychology and Clinical Social Work alongside Psychiatry. For many plans, that turned behavioral health from one gap into three.
Build, Buy, or Lease: How Health Plans Close Behavioral Health Gaps Faster
Direct contracting gives control, but it takes time plans often don't have. A leased behavioral network can bring credentialing-ready providers into reach faster.
Rural Behavioral Health Coverage: Where Telehealth Helps and Where It Doesn't
In rural counties, a few well-placed in-person behavioral providers plus a solid telehealth benefit usually beats a long list of distant contracts.
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