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Proposed rules would offer more protection for seniors enrolled in Medicare Advantage
Proposed rules would offer more protection for seniors enrolled in Medicare Advantage
By Susan Jaffe
Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks...The proposals follow UnitedHealthcare’s decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall.
The government’s response is part of the 148-page announcement of proposed rules and payment rates for next year’s Medicare Advantage plans, which were released last month by the U.S. Centers for Medicare and Medicaid Services. Officials said the terminations a few weeks before Medicare’s Dec. 7 enrollment deadline may not have given seniors enough time to find new doctors, choose a different plan or rejoin traditional Medicare, which does not restrict beneficiaries to a limited network of providers.
The proposals would give beneficiaries more than 30 days’ notice of network changes and providers at least 60 days’ notice of a contract termination. Even Medicare officials need more notice — “no less than 90 days” — so they can ensure that the remaining providers “will continue to meet required network standards.” Officials are soliciting suggestions on how plans should prove that their reconfigured networks are adequate.
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Medicare Advantage rules allow beneficiaries to change plans if they move out of the coverage area or for other special reasons, but not if they lose their doctors or hospitals. Otherwise, they can switch plans once a year, during the fall seven-week enrollment period. Since most beneficiaries are locked into their plans, CMS is considering whether to restrict insurers’ ability to drop doctors during the plan year...“These are exactly the things we talked about with CMS back in the fall,” said Mark Thompson, executive director of the Fairfield County (Conn.) Medical Association, which, along with the Hartford County Medical Association, sued UnitedHealthcare to block the terminations. The American Medical Association and 35 state medical associations and doctor advocacy groups filed legal papers in support of the doctors...A federal judge in December issued an injunction halting the cancellations in those counties, and a panel of three federal appeals court judges in February upheld that decision until the doctors had time to challenge their terminations before independent arbitrators.
- more -
http://www.washingtonpost.com/politics/proposed-rules-would-offer-more-protection-for-seniors-enrolled-in-medicare-advantage/2014/03/23/f89d690c-b126-11e3-9627-c65021d6d572_story.html
By Susan Jaffe
Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks...The proposals follow UnitedHealthcare’s decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall.
The government’s response is part of the 148-page announcement of proposed rules and payment rates for next year’s Medicare Advantage plans, which were released last month by the U.S. Centers for Medicare and Medicaid Services. Officials said the terminations a few weeks before Medicare’s Dec. 7 enrollment deadline may not have given seniors enough time to find new doctors, choose a different plan or rejoin traditional Medicare, which does not restrict beneficiaries to a limited network of providers.
The proposals would give beneficiaries more than 30 days’ notice of network changes and providers at least 60 days’ notice of a contract termination. Even Medicare officials need more notice — “no less than 90 days” — so they can ensure that the remaining providers “will continue to meet required network standards.” Officials are soliciting suggestions on how plans should prove that their reconfigured networks are adequate.
<...>
Medicare Advantage rules allow beneficiaries to change plans if they move out of the coverage area or for other special reasons, but not if they lose their doctors or hospitals. Otherwise, they can switch plans once a year, during the fall seven-week enrollment period. Since most beneficiaries are locked into their plans, CMS is considering whether to restrict insurers’ ability to drop doctors during the plan year...“These are exactly the things we talked about with CMS back in the fall,” said Mark Thompson, executive director of the Fairfield County (Conn.) Medical Association, which, along with the Hartford County Medical Association, sued UnitedHealthcare to block the terminations. The American Medical Association and 35 state medical associations and doctor advocacy groups filed legal papers in support of the doctors...A federal judge in December issued an injunction halting the cancellations in those counties, and a panel of three federal appeals court judges in February upheld that decision until the doctors had time to challenge their terminations before independent arbitrators.
- more -
http://www.washingtonpost.com/politics/proposed-rules-would-offer-more-protection-for-seniors-enrolled-in-medicare-advantage/2014/03/23/f89d690c-b126-11e3-9627-c65021d6d572_story.html
4 replies
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