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Democrats Press Private Medicare Plans to Keep Networks Intact

By Rebecca Adams, CQ Roll Call

October 7, 2015 -- House and Senate Democrats want to require Medicare Advantage plans to keep intact their networks of medical providers for a full year once seniors enroll.

Beneficiaries "should have the peace of mind that their doctors will be covered all year long," said Sen. Sherrod Brown, D-Ohio, on a call with reporters. Brown plans to introduce next week a measure that would allow plans to drop providers only in what Brown called "extraordinary situations," such as when a physician is convicted of a crime or when a provider is unable to continue caring for patients.

Brown is soliciting the support of Sen. Rand Paul, R-Ky., who backed the idea in the past. Rep. Rosa DeLauro, D-Conn., is expected to introduce a House version soon.

Brown and cosponsor Richard Blumenthal, D-Conn., hope that even if the bill is not enacted, the Centers for Medicare and Medicaid Services (CMS) will change its Medicare Advantage policies through its annual call letter, which is expected to be proposed next February.

Brown's announcement comes a week before seniors begin making decisions about their Medicare coverage for next year. The Medicare open enrollment period runs from Oct. 15 through Dec. 7.

A Government Accountability Office report released last week found that "CMS does little to assess the accuracy of the network data" listing providers that plans submit to the agency and that CMS does not assess plan networks on an ongoing basis. "Because a plan’s providers may change at any time, CMS cannot be assured that networks continue to be adequate and provide sufficient access for enrollees," the watchdog group found.

Concerns about the inaccuracy of provider directories and health plans dropping providers without notice drew attention starting in 2013 when UnitedHealthcare unexpectedly ended contracts with tens of thousands of providers in states such as Connecticut and Georgia.

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