Managed Care
Ban on Medicare Advantage "No Cause" Network Terminations
H-285.902
Topic: Managed Care
Meeting Type: Annual
Action: NA
Council & Committees: NA

Policy Subtopic: NA
Year Last Modified: 2019
Type: Health Policies
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1. Our AMA urges the Centers for Medicareþÿ & Medicaid Services (CMS) to further enhance the agency s efforts to
ensure directory accuracy by:
a. Requiring Medicare Advantage (MA) plans to submit accurate provider
directories to CMS every year prior to the Medicare open enrollment period and whenever there is a significant
change in the physicians included in the network;
b. Conducting accuracy reviews on provider directories more
frequently for plans that have had deficiencies;
c. Publicly reporting the most recent accuracy score for each plan on
Medicare Plan Finder;
d. Indicating to plans that failure to maintain complete and accurate directories, as well as
failure to have a sufficient number of physician practices open and accepting new patients, may subject the MA
plans to one of the following: (i) civil monetary penalties; (ii) enrollment sanctions; or (iii) incorporating the
accuracy score into the Stars rating for each plan;
e. Offering plans the option of using AMA/Lexis-Nexis
VerifyHCP system to update provider directory information;
f. Requiring MA plans immediately remove from
provider directories providers who no longer participate in their network.
2. Our AMA urges CMS to ensure that network adequacy standards provide adequate access for beneficiaries and
support coordinated care delivery by:
a. Requiring plans to report the percentage of the physicians, broken down by
specialty and subspecialty, in the network who actually provided services to plan members during the prior year;
b.
Publishing the research supporting the adequacy of the ratios and distance requirements CMS currently uses to
determine network adequacy;
c. Conducting a study of the extent to which networks maintain or disrupt teams of
physicians and hospitals that work together;
d. Evaluating alternative/additional measures of adequacy.
3. Our AMA urges CMS to ensure lists of contracted physicians are made more easily accessible by:
a. Requiring
that MA plans submit their contracted provider list to CMS annually and whenever changes occur, and post the
lists on the Medicare Plan Finder website in both a web-friendly and downloadable spreadsheet form;
b. Linking
the provider lists to Physician Compare so that a patient can first find a physician and then find which health plans