This issue brief examines California's regulatory framework regarding network adequacy and how effectively existing laws provide adequate and affordable access to health care providers, particularly specialists, in the commercial insurance market. Part I of this brief describes California's current regulatory framework for network adequacy and adverse benefit determination review, including the external review process. Part II examines other state and federal requirements for network adequacy and external review and compares them to those in California. Finally, Part III considers new market consolidation forces and discusses the balancing act required within the existing regulatory framework to facilitate affordable health access for all patients in California.
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