C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

Tag Archives: Network Adequacy

HHS Proposes New Regulations Aimed At Stabilizing the Individual Market

Posted in Exchanges, Health Care Reform & ACA
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule  to stabilize the individual and small group markets to entice issuers to continue participation in the exchanges in 2018 despite continued uncertainty surrounding repeal and replacement proposals for the Affordable Care Act (ACA). The proposed rule, published today, would make the following changes… Continue Reading

Network Adequacy for Medicaid Managed Care: New Standards under the Final Rule

Posted in Medicaid
The Medicaid Managed Care Final Rule addresses managed care plan network issues while preserving significant flexibility for the states in designing the standards.  The Rule adds a new regulation (42 C.F.R. § 438.68) on network adequacy standards for medical care and Long-Term Services and Supports (LTSS) as well as one related to availability of services… Continue Reading

Medicaid Managed Care Final Rule: Regulatory Convergence in a Post-ACA World, Novelty, and Modernizing Medicaid Managed Care

Posted in Fraud, Waste & Abuse, Medicaid, Medical Loss Ratios
On May 6, 2016, CMS published the Medicaid managed care final rule in the Federal Register. The Final Rule overhauls Medicaid managed care for the first time in 14 years and tracks many of the industry-wide developments that followed enactment of the ACA. Given the breadth of the rule, Crowell & Moring is covering it… Continue Reading

CMS: Significant Provider Network Changes Gives MAO Enrollees Chance to Change Plans

Posted in Medicare
Medicare Advantage (“MA”) plans may want to think twice before modifying their provider networks.  In an August 27, 2015 letter, CMS announced that MA plan enrollees may elect to change plans if their current plan makes a significant provider network change with substantial beneficiary impact. The letter provides an overview of how CMS will implement… Continue Reading