MedPAC to Analyze MA Network Adequacy, including PAC Access

In a move that acknowledges concerns LeadingAge and other providers have raised in recent years, the Medicare Payment Advisory Commission (MedPAC) initiated work on Medicare Advantage (MA) plan provider networks at its November 8 meeting.

Fleshing out the goals for the research and analysis staff will undertake on this topic, Commissioner Chair Dr. Michael Chernew summarized that "Right now, we are just trying to understand if there is a problem and what it is," and what are beneficiaries' experience with these provider networks related to access and quality.

He admitted there appears to be a problem as several commissioners expressed concerns about both the accuracy of provider directories and the mid-year network changes that place undue burden on beneficiaries as they either hunt for a new provider to continue their treatments/care or incur bills for the full cost of care to maintain a current provider that is now out-of-network.

Commission staff will specifically aim to better understand provider participation in MA networks, which providers enrollees are using, and the impact of MA network adequacy standards on enrollees' ability to access to care. Additionally, in a new-for-MedPAC topic area, staff intend to compare data to identify provider participation trends and patterns in MA and Medicare fee-for-service (FFS), including provider and plan characteristics, changes in provider participation year-over-year, and the quality delivered by these networks.

Commissioners sought additional granularity in the work ahead including asking staff to look at access to care and network adequacy by provider types specifically calling out a need to examine post-acute care (PAC) access and quality within MA networks.

LeadingAge will continue to track this work and provide input on member concerns related to quality skilled nursing facilities and home health agencies being left out of networks because plans have said they are too small, and the administrative burden of credentialing requirements. We are pleased the Commission agrees that this is important and necessary work.