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Medicare Advantage plan provider changes limited under proposed law


Bill would prohibit dropping doctors during open enrollment periods

Medicare Advantage plans would be prohibited from making changes to their provider networks within 60 days of the start of open enrollment periods under a bill introduced in Congress on June 26.

The legislation, known as the “Medicare Advantage Participant Bill of Rights Act,” would also require plans to disclose their reasons for dropping providers from their networks, and require the Centers for Medicare and Medicaid Services to redesign the online tool that enables patients to compare plans.The law’s sponsors, U.S. Rep. Rosa DeLauro (D-Connecticut) and U.S. Sens. Sherrod Brown (D-Ohio) and Richard Blumenthal (D-Connecticut) said they were moved to act by UnitedHealth Group’s decision, beginning late in 2013, to drop thousands of providers from its Medicare Advantage network.

“The timing and scale of UnitedHealth Group’s provider cuts have been extremely disruptive to their Connecticut patients and put them at risk,” DeLauro said in a statement. “We have a responsibility to ensure that Medicare Advantage plans are serving the needs of their participants. Congress has to hold these companies accountable, and make sure they are putting the care of their enrollees ahead of their profits.”

“American seniors spend a lifetime working hard and contributing to our society,” Brown said. “In return, they deserve a strong Medicare program that protects their rights along with their health and wellbeing. This bill would protect patients by making sure Medicare Advantage plans do not remove providers without warning or during the middle of a plan year.“

By prohibiting network changes during open enrollment, the bill would “ensure that enrollees know what providers will be covered before they enroll in a Medicare Advantage plan,” the sponsors said.

United HealthCare first announced plans last November to trim physicians from its Medicare Advantage networks in Connecticut, Florida, New York, Ohio, and elsewhere. Two county medical societies in Connecticut sued the company in response, obtaining a temporary restraining order halting the cuts in that state. Earlier this UnitedHealthcare announced it had begun notifying physicians in Alabama, Georgia, Massachusetts, North Carolina and Tennessee that they were being dropped from the company’s networks.

Responding to the legislation, Terry O’Hara, a United HealthCare spokesman said, “We continue to offer Medicare Advantage enrollees a broad choice of
 primary care physicians and specialists in Connecticut and elsewhere, and
 are committed to ensuring Medicare beneficiaries have access to quality,
 affordable care.”

Brendan Buck, a spokesman for America's Health Insurance Plans, said in a statement, "Health plans are committed to ensuring stable, affordable coverage for the more than 15 million beneficiaries who rely on Medicare Advantage, and have a strong track record of offering high-quality coverage options. There are already strong consumer protections in place including extensive network adequacy standards, and Medicare Advantage remains extremely popular with American seniors."


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Jennifer N. Lee, MD, FAAFP
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