News and Regulations
CMS each year makes adjustments to the Network Adequacy Criteria. In addition, there are policy and regulatory changes that affect network standards. Retium Health provides links to information related to network criteria that is helpful for health plans that work in the Medicare Advantage environment.
CY 2023 Medicare Advantage and Prescription Drug Program Proposed Rule
CMS issued its proposed rule for Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.
CMS is “proposing to require an applicant to demonstrate compliance with network adequacy standards as part of the MA application process for new and expanding service areas and to adopt a time-limited 10 percentage point credit toward meeting the applicable network adequacy standards for the application evaluation”. This will start with CY 2024.
Medicare Advantage and Section 1876 Cost Plan Network Adequacy Guidance
CMS issued an update to their network adequacy guidance on March 4, 2022. This document is developed by CMS and offers details regarding MA network adequacy requirements, specialty types, quantitative measurements of network adequacy, compliance and enforcement efforts, instructions to upload HSD table, and exception requests instructions.
HSD Reference File
Each year CMS updates their HSD table to account for changes in county designations (changes in population) and feasibility to meet time and distance criteria based on availability of providers.
On CMS page see Downloads and click on HSD_2022_Reference File_updated_01_07_2022