To enhance beneficiary and provider protections and improve transparency in the Medicare Advantage market, and for other purposes.

United States115th CongressHR-7340House of Representatives
Updated: Jan 2, 2019

Summary

Medicare Advantage Bill of Rights Act of 2018 This bill establishes 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.

Bill texts

Available versions
Introduced (House)View official text

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Timeline

  1. Introduced in House

  2. Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

    House of Representatives

  3. Referred to the Subcommittee on Health.

    House of Representatives

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