Medicare Advantage Network Adequacy

This document summarizes a telephone discussion among states cms the national association of medicaid directors and icrc regarding medicare advantage network adequacy requirements and.

Medicare advantage network adequacy.

In the latest proposed updates to medicare advantage ma and medicare part d cms codified exiting network adequacy requirements and incentivized ma plans to contract with telehealth providers in addition the proposed rule also included a number of provisions to address drug pricing such as lowering beneficiary cost sharing on some of the most expensive prescription drugs promoting. The centers for medicare medicaid services cms regulations at 42 c f r. Medicare advantage network adequacy requirements d snps and state contracting options. At its discretion cms may review networks at other times for instance when a plan terminates a contract with a provider when it changes ownership or when.

This week our in focus section examines new guidance issued by the centers for medicare medicaid services cms regarding medicare advantage ma plan network adequacy requirements. Assure that retina specialists are viewed distinctly from ophthalmologists in health plans. Require plans to use apples to apples comparisons of retina specialists when determining quality and cost efficiency especially given the age and multiple health conditions of their patient. Brief description of rppo and pffs network requirements.

On june 17 2020 cms released updated medicare advantage and 1876 cost plan network adequacy guidance for medicare advantage ma health plans to use now for contract year 2021 network submission. Cms expects that organizations continuously monitor their contracted networks throughout the respective contract year to ensure compliance with the current network adequacy criteria. The proposal has been in the works for quite some time now and is of no surprise given that a previous review by cms found forty five percent of medicare. Medicare advantage network adequacy.

Integrated care resource center. Asrs is advocating to. When is network adequacy assessed. Medicare advantage and section 1876 cost plan network adequacy guidance last updated.

Cms is only certain to assess a plan s network upon application for a new contract or expansion of a contract s service area. June 17 2020 1. Network adequacy medicare advantage criteria guidance lastupdated. The office of management budget omb recently approved a long standing proposal from the centers for medicare medicaid services cms to change their method of network adequacy review.