ASCRS Urges CMS to Ensure Beneficiaries Have Continued Access to Specialty Care in Medicare Advantage (MA) Plans

This week, ASCRS submitted comments in response to CMS’ request for information (RFI) included in the 2018 MA Payment Rate and Policy Letter (known as the Call Letter). When issuing the final 2018 Call Letter, CMS asked for input from stakeholders for ways to improve the program in future years. Specifically, the RFI asked for recommendations to “improve and support the doctor-patient relationship.” In response, ASCRS noted that the best way to improve and support that relationship would be to ensure continued access to specialty care in MA plans. We have heard from members that MA plans continually put up barriers through increased regulatory burdens, such as prior authorization, and limit access by narrowing provider networks, sometimes in the middle of the benefit year. We recommend CMS require standardized prior authorization procedures and ensure network adequacy and up-to-date provider directories. In addition, we request CMS limit MA plan risk-adjustment audits, which become a burden for practices who must provide patient charts for these audits.

In addition to our comments on the MA Call Letter, we continue to work with the medical community to advocate for regulatory relief from several different programs. We will keep you updated.