Medicare Advantage Bill of Rights Act of 2015
Bill journey · stage 2 of 5
Under committee review
What it doesSummary introduced in senate (Dec 10, 2015)
Medicare Advantage Bill of Rights Act of 2015
This bill amends title XVIII (Medicare) of the Social Security Act to establish limits on the removal of Medicare Advantage (MA) providers by MA organizations. Within 60 days before the first day of the annual coordinated election period for an MA plan, an MA organization may remove a provider from the plan only if the provider is: (1) medically negligent, (2) in violation of a legal or contractual requirement, or (3) otherwise unfit to furnish items and services as required.
An MA organization may remove a provider from an MA plan only after the completion of a fair notice and appeal process. Additionally, the MA organization must: (1) provide written notification of the removal to each enrollee receiving items or services from the provider, and (2) ensure that the removal satisfies certain continuity of care requirements.
The bill also establishes network adequacy requirements. Specifically, when establishing a plan network, an MA organization shall consider specified factors related to provider availability and the timely provision of care. Furthermore, an MA organization must annually certify to the Centers for Medicare & Medicaid Services that providers in each of its plan networks are able to provide services and meet enrollees' needs as required.
Sanctions for noncompliance with the bill's requirements apply.
What just happenedDec 10, 2015
Read twice and referred to the Committee on Finance.
Who’s behind it
- Introduced in SenateDec 10, 2015
- Dec 10, 2015IntroReferral
Read twice and referred to the Committee on Finance.
Finance Committee - Dec 10, 2015IntroReferral10000
Introduced in Senate