CMS Proposes New Medicare Advantage Network Rules

The Centers for Medicare & Medicaid Services (CMS) recently announced it is considering new rules aimed at safeguarding Medicare Advantage enrollees when health plans significantly reduce their physician networks. 

The CMS announcement follows UnitedHealthcare's termination of thousands of Texas physicians from its Medicare Advantage plans last fall. The insurer's actions had national implications.

Connecticut's Fairfield County Medical Association and Hartford County Medical Association sued United after the organizations learned the insurer began removing physicians from its Medicare Advantage network in October. The American Medical Association and TMA filed supporting amicus briefs in the case. For more on the lawsuit, read "A Bitter Pill." 

TMA officials say the legal action and subsequent media coverage helped spur CMS to act. 

CMS is considering requiring Medicare Advantage organizations to provide:

  • Enrollees at least 30 days' notice of significant network changes;
  • Health professionals at least 60 days' notice of a contract termination; and 
  • CMS regional office account managers at least 90 days' notice before the effective date of significant changes to provider networks. 

According to CMS, notification would allow for coordination between the Medicare Advantage organizations and their account managers "to ensure that affected providers and enrollees receive timely notification of such changes." The 90-day advance notice also would help CMS ensure the Medicare Advantage organizations "will continue to meet required network standards if the planned network changes are implemented." The rules could be finalized as early as April 7.

Action, April 1, 2014