Every Medicare Advantage plan that is due for its three-year entire network review will receive a letter from the agency that will specify which contracts are due for review, the reason for the request, a description of the CMS' network adequacy requirements and instructions on how to upload their networks. Those letters will be sent to plans that have not had an entire network review in the previous 12 months.
Approximately 304 Medicare Advantage plan contracts will receive the initial review request, the CMS estimates.
If the CMS finds network deficiencies, the insurer may be subject to enforcement actions, including civil monetary penalties or an enrollment freeze.
The CMS in January revealed 45.1% of provider directories of Medicare Advantage plans reviewed were not accurate.
For that report, the agency examined the online provider directories of 54 Medicare Advantage plans, which represents approximately one-third of all Advantage plans, between February and August of 2016. Combined, these plans have a network of 5,832 providers.
The inaccuracies ranged from the provider not being at the location listed, wrong phone numbers and the listing incorrectly noting the provider was accepting new patients.
Before submitting the request to the OMB, the CMS is collecting comments on the proposal through Aug. 18.
Since 2004, the number of beneficiaries enrolled in private Medicare plans has more than tripled from 5.3 million to 17.6 million in 2016, according to the Kaiser Family Foundation.
An edited version of this story is also in Modern Healthcare's July 24 print edition.