The Centers for Medicare & Medicaid Services (CMS) last week issued a regulation for Medicare Advantage (MA) plans that eliminates time and distance limits from network adequacy requirements for dialysis facilities.
Network adequacy requirements for health plans ensure that patients can have access to all necessary providers with reasonable promptness. Time and distance limits prescribe a maximum driving time or distance in miles that a consumer must travel to get to a doctor or facility. The limits are higher in rural areas.
CMS replaced the time and distance limits with another standard, a network “consistent with the prevailing community pattern of health care delivery in the area.” This standard is usually applied for services for which patients don’t regularly travel to receive. We expect that this change will lead to smaller numbers of dialysis clinics included in MA plan networks and make Medicare Advantage plans less attractive to ESRD patients when they are able to enroll in them for 2021. DPC opposed any loosening of these protections and is considering potential legal options to reverse this decision.