Medicare Advantage Plans: Government Oversight & Ind Advcy
Medicare Advantage Plans (“MAPs”) have had tremendous growth in enrollment in recent years. Almost 50% of Medicare beneficiaries are covered by MAPs and this is expected to continue to grow at a rapid pace. Working with MAPs has proven to be challenging for suppliers in their ability to access networks, negotiate rates, and work through a sometimes-non-existent appeals process. And so DME suppliers quite naturally ask what the federal laws are that govern MAPs. On the one hand, federal laws governing MAPs are quite extensive. However, only a small portion of the federal laws pertain to the relationship between the MAPs and the providers/suppliers that serve the patients covered by the plans. Much of the law is aimed to (i) protect covered lives and (ii) set minimum requirements for coverage, networks, complex reimbursement mechanisms. This program will discuss the current MAP environment and the federal laws that govern them. The program will further discuss how these laws affect DME suppliers as they provide services to patients covered by MAPs. The program will then pivot to discuss the most important issues DME suppliers must face as they work with MAPs. Finally, the program will discuss the work being done to educate Congress, CMS, and the industry and the resources available to help DME suppliers navigate these plans.