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January 26, 2022

Medicare Program Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs: Proposed Changes to Medicare Advantage Network Adequacy Rules

This Bulletin is brought to you by AHLA’s Payers, Plans, and Managed Care Practice Group.
  • January 26, 2022
  • Erin Martino , Fresenius Medical Care North America

The Proposed Rule revises 42 C.F.R. § 422.116 and requires that, beginning with contract year 2024, a Medicare Advantage (MA) plan applicant demonstrate that it meets the network adequacy requirements for the pending service area prior to CMS approval of an application for a new or expanded service area. CMS may deny an application on the basis of an evaluation of the applicant’s network for the new or expanding service area.

  • Payers, Plans, and Managed Care
  • Government Reimbursement

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