The CMS needs to do a better job ensuring that there are adequate networks for Medicare Advantage plans, according to a new analysis by the Government Accountability Office.
The agency's oversight is now deficient in a few key ways. First its definition of adequate networks for Advantage plans doesn't take into account how often a provider practices at a given location or whether or not they are taking new patients.
“Without taking availability into account, as is done in some other programs, MA provider networks may appear to CMS and beneficiaries as more robust than they actually are,” the report found.
Another issue is that the CMS does little to assess the accuracy of the network data that plans submit in their applications. It also does not outline what plans should do when they want to terminate an agreement with a provider.
The issue is of concern as some Advantage plans have been narrowing their provider networks, prompting concerns about ensuring enrollee access to care.
The report was requested by U.S. Sens. Sherrod Brown (D-Ohio), Richard Blumenthal (D-Conn.), and Sheldon Whitehouse (D-R.I.), and U.S. Reps. Rosa DeLauro (D-Conn.), Joe Courtney (D-Conn.), Elizabeth Esty (D-Conn.), Jim Himes (D-Conn.), and John Larson (D-Conn.).
Brown and DeLauro are authors of the Medicare Advantage Participant Bill of Rights, legislation that was developed as a result of UnitedHealth's dropping of doctors from their Medicare Advantage networks, including the entire Yale-New Haven (Conn.) Hospital network.
“Today's report underscores the horror stories I've heard from too many seniors,” Brown said. “Medicare Advantage enrollees should be able to select a plan with an adequate provider network that meets all of their needs and should have the security that their providers will not be dropped from the network in between enrollment periods.”
In response to the findings, the CMS says it's taking steps to turn things around. For instance, 2016 Medicare Advantage contracts indicate that provider directories must be kept up to date on whether they are accepting new patients. The agency is also considering making a rule to strengthen its oversight of network adequacy.
In regards to terminating providers, the CMS outlines that affected beneficiaries be notified that a change is taking place, and in the future it is considering having plans submit what information they send to beneficiaries so that the CMS can see whether adequate information is conveyed.
