- Center on Health Equity and Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
CMS Seeks to Protect Elderly with New Medicare Advantage Rules
New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors.
New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors. Some health insurance companies, including UnitedHealthcare, have recently slimmed down their provider networks, meaning certain seniors have not had adequate time to find new doctors or to choose a different health plan.
The network reduction affects nearly 16 million seniors enrolled in private MA plans, and it has created quite a stir among providers and policy makers. Traditional MA rules allow beneficiaries to change their plan for reasons such as a change in their place of residency, but not if they lose a doctor or hospital in their network. For this reason, the US Centers for Medicare & Medicaid Services (CMS) suggests that the proposed changes are necessary.
“Recent significant mid-year changes to MAOs’ [Medicare Advantage organizations’] provider networks have prompted CMS to reexamine its current guidance on these requirements and to consider augmenting such guidance in response to such changes,” said the announcement.
If accepted, the plan would provide Medicare beneficiaries with more than 30 days’ notice of any network changes, and would give providers no less than 60 days’ notice of contract termination. Insurers who drop providers will be required to inform their subscribers with a letter that informs them of any changes, as well as of their rights, before open enrollment begins.
“These are exactly the things we talked about with CMS back in the fall,” said Mark Thompson, executive director of the Fairfield County (Conn.) Medical Association. “Someone was paying attention and listening to us.”
UnitedHealthcare reasons that network cuts were a necessary response to federal reimbursement cuts under the Affordable Care Act. Other insurers, like America’s Health Insurance Plans, also cite concerns over the changes. They say the proposal would present challenges for insurers’ contract negotiations, and that notifying beneficiaries of terminations could become burdensome.
Around the Web
Draft Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors [Kaiser Health News]
Data analysis showed that 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later; both Democrats and reproductive rights organizations are pressuring the Biden administration to ensure health insurers fully cover contraception; CMS implemented Medicare changes in March that limited access to blood tests that help transplant recipients ensure their organs remain healthy.
Read More
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen
The Impact of Nurse Practitioner Attribution in Medicare Shared Savings ACOs
December 5th 2023Allowing nurse practitioners to serve as attribution-eligible providers for Medicare Shared Savings Program accountable care organizations leads to no change in hierarchical condition category risk scores and modest growth in attributed beneficiaries.
Read More
Insufficient Data, Disparities Plague Lung Cancer Risk Factor Documentation
September 24th 2023On this episode of Managed Care Cast, we speak with the senior author of a study published in the September 2023 issue of The American Journal of Managed Care® on the importance of adequate and effective lung cancer risk factor documentation to determine a patient's eligibility for screening.
Listen
