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Diane Publishing Books
Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy
James Cosgrove (au)
Medicare Advantage Organizations (MAOs) contract with a network of providers to manage health care delivery to their enrollees. MAOs can initiate or terminate contracts with providers at any time for any reason. Recently, some MAOs have been narrowing their provider networks, prompting concerns about ensuring enrollee access to care and CMSäó»s oversight of MAO compliance with network adequacy criteria. This report examines (1) how the Centers for Medicare & Medicaid Services (CMS) defines network adequacy and how its criteria compares with other programs; (2) how and when CMS applies its criteria; and (3) the extent to which CMS conducts ongoing monitoring of MAO networks; and (4) how CMS ensures that MAOs inform beneficiaries about terminations. Tables. This is a print on demand report.
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