CMS to Review MA Networks in 3-Year Cycles Starting in 2019
The Office of Management and Budget (OMB) has approved the Centers for Medicare & Medicaid Services’ (CMS’ ) plan to conduct provider network adequacy (PNA) audits for Medicare Advantage Organizations (MAOs) every 3 years, starting in 2019, according to a January 10 HPMS memo. The 2019 new plan and service area expansion applications require plans to attest that their network meets CMS adequacy requirements, rather than providing the information for CMS to review as part of the application process and paving the way for greater scrutiny by CMS during the 3-year review cycles. Deficiencies may result in enforcement actions, such as civil money penalties or enrollment sanctions. BluePeak’s mock PNA audits can help your team find deficiencies BEFORE CMS does.
