GAO: CMS should do more to ensure adequate access to care for MA enrollees

The Centers for Medicare & Medicaid Services should do more to ensure that Medicare Advantage organizations offer adequate provider networks to meet enrollees’ needs, according to a new report by the Government Accountability Office. Specifically, GAO said CMS should augment its network adequacy criteria to address provider availability; verify provider information submitted by MA organizations; require all MAOs to periodically submit their networks for assessment against current Medicare requirements; and set minimum requirements for MAO letters notifying enrollees of provider terminations and require MAOs to submit sample letters to CMS for review. In the report, the Department of Health and Human Services concurs with the recommendations. Ashley Thompson, AHA acting senior executive for policy, said, “We believe GAO’s recommendations to CMS on provider network adequacy in the Medicare Advantage program could improve access to needed services for beneficiaries.”