The Maryland Society of Pathologists (MSP) and the CAP enlisted with other physician specialties and the Maryland State Medical Society (Med-Chi), to urge amendments to a proposed state Insurance Department network adequacy regulation that omitted any consideration of network adequacy criteria for hospital-based physicians. The draft rule removed previously proposed criteria, issued for public comment in 2020, assessing health plan network adequacy with an explicit determination of whether health plans had contracted with hospital-based physicians, laboratories, and radiological facilities. The revised rules were reviewed at a public departmental hearing on August 15, 2022, in which the CAP testified on behalf of MSP in support of the Med-Chi letter.

The physician coalition, comprised of pathology, radiology, emergency medicine, and anesthesiology, led by Med-Chi urged the agency to revise the draft to include a requirement on health plans to "maintain a network in sufficient number, geographic locations, and practicing specialties, including timely on-site access to emergency services, on-call physicians and hospital-based physicians." The coalition cited existing Maryland regulations defining a hospital-based physician as "an anesthesiologist, pathologist, radiologist, neonatologist, hospitalist, intensivist, or emergency medicine physician that practices exclusively within an accredited hospital and provides care to enrollees only as a result of the enrollees being directed to the hospital."

The coalition affirmed, “lastly in referencing hospital-based physicians, it is important that we acknowledge that some of these providers are not only “hospital-based” but practice across multiple settings and should be accounted for under network adequacy sufficiency standards. The Administration must ensure that carriers are evaluating and reporting sufficiency for those specialties that work not just in hospitals but across other settings and that they are being accounted for in the standards."

To date, the CAP has worked with state pathology societies and state medical associations to secure the enactment of network adequacy laws that require health plans to be evaluated for enrollee access to hospital-based physician specialists, specifically inclusive of pathologists, in Virginia, Washington, New Hampshire, Virginia, and Louisiana. In addition, other states, like West Virginia, as the result of the CAP’s advocacy, have laws to require health plans to report their processes for monitoring enrollee access to hospital-based physicians, including pathologists.

The CAP will continue to work with MSP and the coalition to secure favorable network adequacy regulations.