CMS Moves Forward with Plan to Increase Oversight of MA Plan Networks

Casey SchwarzMedicare Watch0 Comments

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This week, the White House’s Office of Management and Budget (OMB) approved a Centers for Medicare and Medicaid Services (CMS) request to increase the frequency of review for Medicare Advantage (MA) plan networks.

Under current rules, CMS rarely evaluates a plan’s compliance with the standards for network adequacy—how many in-network providers it has in various specialties throughout the geographic region it serves.  CMS reviews a plan’s network when the plan first starts operating, when it expands to a new area, or when triggering events occur, such as complaints about inadequate networks. Most of the reviews following triggering events are limited—looking at only a particular region or specialty.  This means that for many plans, the network is not formally reviewed by CMS after its initial application.

This lack of oversight may contribute to some of the problems with MA networks the Government Accountability Office, advocates, and even CMS have raised in the past: namely, that MA networks seem to be increasingly narrow, that mid-year network changes can be confusing and harmful to beneficiaries, and that communications to enrollees about MA networks are often inaccurate or incomplete. Last year, Medicare Rights wrote about the findings from a review of 54 MA organizations showing widespread inaccuracies in MA provider directories published online. According to the review, around 45% of the provider directory locations listed in these online directories were inaccurate.

The new rules would allow CMS to review plan networks every three years, starting in 2019.  Medicare Advantage plans will upload their network information into a centralized federal database for review if they have not undergone a whole-network review in the previous three years.  The agency estimates that 304 plans will be subject to the more thorough review next year.

Read our previous blog post on inaccurate provider directories.

Read the Government Accountability Office report on network adequacy.

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