Lexology January 19, 2022

Continuing our series analyzing the recently proposed Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs rules (Proposed Rule), this post focuses on a few items that are specific to Medicare Advantage (MA) Plans. Here, we discuss CMS’ proposals to (1) require initial and expanded services area applicants to submit their proposed contracted networks during the application process, (2) clarify that beneficiary access requirements during disasters and emergencies apply when there is a “disruption in access to health care,” (3) return to medical loss ratio (MLR) reporting requirements from 2014 – 2017, and (4) adjust how the maximum out-of-pocket (MOOP) limit is calculated for dually-eligible beneficiaries.

Network Adequacy Standards

MA regulations require...

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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, Provider
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