Proposed rules target Medicare Advantage network changes

Following UnitedHealth's controversial move to drop 19 percent of its Medicare Advantage network, new rules call for insurers to give members and providers more notice of major network changes and terminations, Kaiser Health News and the Washington Post reported.

The newspapers took a deeper look into the 148 pages of proposed rules for the Medicare Advantage program, which the Centers for Medicare & Medicaid Services released in February and included a 2015 reduction in payments to Medicare Advantage plans.

Under the proposals, Medicare Advantage organizations would have to give beneficiaries more than 30 days' advance notice of network changes, providers at least 60 days' advance notice of a contract termination and Medicare officials at least 90 days' notice of planned terminations.

Beneficiaries can't change plans if they lose their doctors or hospitals and have to wait until the annual fall open enrollment period, so federal officials want to discourage insurers from dropping providers during the plan year. For instance, CMS wants insurers to disclose plans for provider terminations in the letter of changes they have to send to members each year before open enrollment.

America's Health Insurance Plans said such Medicare Advantage changes would hurt insurers' contract negotiations with providers and weaken their ability to enforce termination provisions in provider contracts, KHN noted.

CMS also targeted excessive network cuts outside of Medicare Advantage plans. Last month it proposed a policy that would require payers to expand their exchange networks to include 30 percent of essential community providers in their areas or risk being kicked out of the new online marketplaces. And provider groups, including the American College of Physicians, have called on state and federal officials to impose tighter restrictions on narrow provider networks.

For more:
- here's the KHN/Post article
- check out the proposed rules (.pdf)

Suggested Articles

An estimated 73 million Americans with commercial health insurance face limited choices, according to a new American Medical Association study.

Absent adequate reimbursement for time spent on complex patient care, specialists are finding it harder to sustain their practices.

Tennessee released its proposal to CMS to become the first state to convert federal Medicaid funding into a block grant.