Notifications for MA Providers - Provider Newsletter October, 2023

For contract year 2024, CMS has made some changes in the requirements for notifying Medicare Advantage (MA) enrollees of provider contract terminations. Here is a summary of the changes.

1. Good-faith effort vs. mandatory notifications

CURRENT: Medicare Advantage Organizations (MAOs) must make a good-faith effort to notify in writing all enrollees who are patients seen on a regular basis by the provider whose contract is terminating, at least 30 days before the termination effective date, regardless of whether the termination is for cause or without cause. When the terminating provider is a primary care provider (PCP), all enrollees who are patients of that PCP must be notified.

2024: MAOs must notify enrollees of all provider terminations at least 30 days prior to the termination date. Making a good-faith effort (as opposed to actually delivering timely notice) is an exception to the rule that may only be applied in certain “for-cause” terminations. Because providers and payers must give each other a 60-day advance written notice of a ”no-cause” termination, there are no good-faith exceptions for this type of termination.

2. Notification time frame for PCP and behavioral health provider terminations

CURRENT: MAOs must notify certain enrollees (see #4 below) at least 30 days in advance of a terminating PCP or behavioral health provider’s termination date.

2024: MAOs must notify certain enrollees at least 45 days in advance of a terminating PCP or behavioral health provider’s termination date. The scope of primary care includes both palliative and end-of-life care.

3. Notification delivery for PCP and behavioral health provider terminations

CURRENT: MAOs must send certain enrollees written notice of a pending PCP or behavioral health provider termination.

2024: MAOs must send certain enrollees written notice of a provider termination and make at least one attempt at phone notification.

4. Enrollees who must get notice when a PCP or behavioral health provider terminates

CURRENT: MAOs must notify all enrollees who are patients of a terminating PCP. MAOs must notify all enrollees who are patients seen on a regular basis by a terminating behavioral health provider, including patients who are currently receiving care or have received care within the past three months from the terminating behavioral health provider.

2024: MAOs must notify enrollees who are currently assigned to that PCP and to enrollees who have been patients of the terminating PCP or behavioral health provider within the past three years.

5. Content requirements for written notifications to patients

For 2024: Written notifications about pending provider terminations must include the following information:

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The date that the provider will no longer be in-network

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The names and phone numbers of in-network providers the enrollee can access for continued care (may be supplemented with information about accessing a current provider directory)

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How the enrollee can request continuation of care with the terminating provider

•

The MAO’s customer service phone number, TTY number, and hours of operation

•

An explanation of the annual election period and the MA open enrollment period

•

An explanation that the enrollee can contact 1-800-MEDICARE to request assistance in identifying and switching to another coverage, or to request consideration for a special election period

Please visit the CMS website for more information about the 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F).

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CMS: Notifying MA enrollees of provider terminations

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