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Senate Democrats Introduce Legislation to Crack Down on “Ghost Networks”

Sen. Ron Wyden (D-OR) and Sen. Tina Smith (D-MN) introduced legislation cracking down on “ghost networks,” increasing enforcement efforts and allowing the federal government to issue civil monetary penalties to group health plans found out of compliance. 

This legislation takes aim at inaccurate provider directories after a Government Accountability Office (GAO) report released in March of this year found that ghost networks are one of the barriers to accessing mental health care.

The legislation increases requirements for group health plans. Starting three years after enactment, the legislation:

  • Requires group health plans to annually conduct an audit of their directories through an independent entity not associated with the plan or issuer and requires HHS to conduct annual audits on group health plans;

  • Increases network adequacy requirements; and

  • Allows the federal government to issue civil monetary penalties against any group health plan or issuer found out of compliance with the network adequacy and directory accuracy requirements.

Outlook: HR Policy will further analyze the legislation’s impact on employer plans and keep members up to date on whether it is included in the larger bipartisan mental health package expected from the Senate Finance Committee in the coming weeks. 

Published on: November 18, 2022

Authors: Margaret Faso

Topics: Federal Health Care Reform, Transparency, Quality and Cost Containment

Margaret Faso

Director of Health Care Research and Policy, American Health Policy Institute and HR Policy Association

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