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CMS Requests More Oversight Over Medicare Advantage


July 24, 2017

The CMS recently requested that the Office of Management and Budget at the White House expand the Agency’s oversight of Medicare Advantage networks, according to a recent Federal Register notice.

Under current policy, the CMS only reviews Medicare Advantage networks that “trigger” a review through certain events, like when a new plan enters Medicare Advantage or a compliant is filed against a plan’s network. Thus, a number of networks can go years with a full review, and enter new regions without ever being reviewed before doing so.

The CMS is seeking the authority to collect information from all Medicare Advantage networks that haven’t undergone a full review in the previous 3 years.

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“This proposed collection of information is essential to appropriate and timely compliance monitoring by CMS, in order to ensure that all active [Medicare Advantage] contracts offering network-based plans maintain an adequate network,” the CMS wrote.

This proposal will need approval from the Office of Management and Budget.

The request notes that “to enforce this requirement, CMS has developed network adequacy criteria which set forth the minimum number of providers and maximum travel time and distance from enrollees to providers, for required provider specialty types in each county in the United States and its territories.”

If approval is granted, insurers that are found to be deficient or to have incorrect information could be subject to penalties or Medicare Advantage enrollment freezes.

The Agency is requesting public comment until August 18, 2017—after which it will officially submit this request to the White House’s Office of Management and Budget.

David Costill

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