May 16, 2016

Mike Adelberg: Network Adequacy Accountability Front and Center in 2016

So far in 2016, both the Centers for Medicare and Medicaid Services (CMS) and state regulators have shown they are serious about implementing and enforcing accountability measures for network adequacy.  

In early April, CMS revealed that it had already granted special enrollment periods (SEPs) to 15,000 Medicare Advantage beneficiaries whose health care coverage was seriously altered by mid-year provider network changes. In the April 7 edition of Medicare Advantage News, FaegreBD Consulting senior director Mike Adelberg said the SEPs provide “another example of CMS taking provider network changes increasingly seriously.”  

On March 22, America’s Health Insurance Plans (AHIP) unveiled a monitoring pilot that will verify provider-network information. The trade group expressed hope that 100,000 providers would participate in the new program. Adelberg applauded the program, but also said that programs like AHIP’s can’t succeed unless health plans work independently to keep their directories up to date. 

“At the very least, [health plans should] be looking at their provider contracts and assuring that they can incent providers to keep directories current,” Adelberg said. “They should also be looking at their directory error rate and measuring improvement. We know CMS is.”

Additional steps, particularly in the Medicare Advantage program, continue to be taken, by the industry and CMS to examine provider networks and increase provider directory accuracy.

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