CMS To Issue New Protections for MA Beneficiaries Next Month
Federal officials have signaled that new rules are being developed to enhance protections for Medicare Advantage beneficiaries if their insurers decide to narrow their provider networks, the Washington Post/Kaiser Health News reports.
According to the Post/KHN, the Obama administration hinted at the expected regulations last month, when CMS issued proposed rules for MA plan payment rates. The decision to issue the protection proposals was driven in part by UnitedHealthcare's decision last fall to narrow its physician networks for its MA plans in at least 10 states, a move that dropped thousands of physicians from the networks.
Currently, MA beneficiaries are allowed to switch plans during the annual seven-week open enrollment period for MA plans -- which takes place in the fall -- if they meet the requirements for certain special exemptions or move out of a plan's coverage area. Otherwise, beneficiaries are locked into their plans, even if their provider network is changed or reduced, the Post/KHN reports.
Preliminary Details of New Rules
According to the Post/KHN, beneficiaries would have to be notified at least 30 days in advance of any provider network changes, while providers would have to be informed least 60 days ahead of any contract terminations. Medicare officials also would have to be told at least 90 days in advance of any network changes to ensure that providers remaining in networks "will continue to meet required network standards." CMS officials are seeking ideas on how plans can demonstrate that they still meet network standards, the Post/KHN reports.
In addition, the rules would require insurers to include in their annual open enrollment notices any plans to drop providers from networks in the upcoming year. Insurers also would be required to detail patients' rights if any network providers leave the plan in the coming year.
CMS is expected to issue the final rules by as early as April 7 (Jaffe, Washington Post/Kaiser Health News, 3/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.