PRA Listing: 2021 ANOCs and EOCs and Network Adequacy

Over the past month or so, we’ve seen a number of items posted in the Paperwork Reduction Act, or PRA, listing. Today I’m focusing on a couple and provide some thoughts.  

On April 6, the Centers for Medicare & Medicaid Services (CMS) posted the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) models along with their summary of changes based on the 60-day Federal Register public comments. The supporting statement packaged with the ANOCs outlined the standard information, including estimates of labor burden. The agency estimates 732 Medicare Advantage (MA) Organizations and 63 Part D sponsor contracts will be responsible for producing ANOCs and EOCs. Hours and wage estimates and total burden of hours are also included. They estimate it will take an average of 12 hours to develop and submit the required information to CMS. This estimate has to include different factors, such as number of plan benefit packages a sponsor has, and the fact that ANOCs are much smaller than EOCs. They again anticipate the average EOC will be 238 pages. 

In recent years, these documents have been posted as final, but are followed by supplemental memoranda with additional corrections. If you notice anything substantively amiss in these documents, alert the agency now, as it may save you time and corrections later. 

Also, on April 6, CMS posted CMS-10636 regarding the triennial network adequacy review. CMS reviews MA provider networks on a 3-year cycle, unless there is an event that triggers an intermediate full network review. According to the agency, when selecting contracts for the triennial review period, they will pull a random sample from the list of active contracts, including contracts that have never undergone a full network review and other active contracts, regardless of when the contract’s last full network review occurred in the Health Plan Management System (HPMS). CMS will review all contracts that have never undergone a full network review in HPMS. In the posted package, CMS removed some references to procedural changes, and they note there are no changes to network adequacy requirements. 

This will be an interesting one to follow, looking at the numbers. As part of the network reviews, they expect to review 140 of an estimated 633 contracts in the first year of the triennial review cycle. Keep in mind, between June 2018 and June 2019, CMS performed full network reviews on 438 of the active contracts at that time. 

Another interesting factor is that CMS has proposed in CMS-4190-P to codify network adequacy methodology for MA plans, including proposing to reduce the required percentage of beneficiaries that must reside within the maximum time and distance standards from 90% to 85%. It is unclear if CMS has data showing if this slight adjustment would help sponsors meet the adequacy requirements, as each rural area tells its own story. We shall see if this provision is finalized.