Crosswalk: Network Adequacy Guidance

Form

Change

Information Collection Guidance:
MA Network Adequacy Guidance

Includes language regarding proposed
changes around initial applicant network
submission requirements

Information Collection Guidance:
MA Network
Adequacy Guidance

Adds language related to applicants who
utilize LOIs as a reason for a
triggering event

Information Collection Guidance:
MA Network
Adequacy Guidance

Includes language regarding proposed
network credits for new applicants

Current Location

Reason
CMS-4192-F establishes revisions at 42 C.F.R. § 422.116 which would establish the requirement that applicants for a new or expanding
service area must demonstrate compliance with network adequacy standards as part of an MA application and that CMS may deny an
application on the basis of an evaluation of the applicant's network.

Introduction
CMS-4192-F requires that applicants who utilize LOIs to meet network adequacy standards during the application process must submit their
network for evaluation during the first year the contract is operational.
Triennial Nework Adequacy Reviews
New or Expanding Service Area Appliant Credit CMS-4192-F establishes that an applicant for a new or expanding service area will receive a 10 percentage point credit towards the
percentage of beneficiaries residing within published time and distance standards for the contracted network
in the pending service area, at the time of application and for the duration of the application review