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Bipartisan House Letter to CMS Seeks Changes to MA Plans to Address Narrow Networks that Exclude Specialists and Reduce Access to Care

Following advocacy from the Alliance of Specialty Medicine, Rep. Andy Harris, MD (R-MD), and Rep. Ami Bera, MD (D-CA), led a letter, with 13 bipartisan members of the House signing, to CMS administrator Seema Verma, expressing concern for narrow networks in health insurance plans that potentially exclude specialists and reduce access to care. The members outlined the following recommendations for CMS to consider in future rulemaking:

  • Ensure Medicare Advantage (MA) network adequacy requirements include appropriately specific standards for specialties and subspecialties;
  • Requiring plans to maintain accurate, real-time provider directories;
  • Incentivize plans to maintain adequate networks of specialists and subspecialties;
  • Require plans to provide reasonable notice regarding termination of a provider’s in-network status, as detailed information as possible on the cause for termination, and any possible ways to re-enter the network; and
  • Examine expanding specialty designation taxonomy codes for specialties and subspecialties.

ASCRS and the Alliance will continue to encourage CMS to prioritize ensuring MA plan networks are robust enough to offer beneficiaries a choice of physicians and the assurance that they will be able to use their MA benefits for the treatments they require.

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