CMS Advances Policy Goals Through Network Adequacy Flexibility
This Bulletin is brought to you by AHLA’s Payers, Plans, and Managed Care Practice Group.
- July 02, 2020
- Jeff Wurzburg , Norton Rose Fulbright LLP
Medicare Advantage Organizations (MAOs) are required to “[m]aintain and monitor a network of appropriate providers that is supported by written agreements and is sufficient to provide adequate access to covered services to meet the needs of the population served.” Network adequacy rules “protect beneficiaries by ensuring that most, if not all, of the beneficiaries enrolled in a plan have access to providers within a reasonable time and distance from where the beneficiaries reside.” CMS has required that MAOs contact with a sufficient number of providers and facilities to ensure that 90% of beneficiaries have access to at least one provider and facility type within maximum time and distance standards.