Ama Policy

Legislation for Assuring Equitable Participation of Physicians in Medicare Advantage H-330.916

Continuity of Care Post-Contract-Med. Adv., Termination-Due Process-Med. Adv., Termination-Med. Adv.

Our AMA seeks to have the CMS, while contracting with Medicare Advantage organizations for Medicare services, require the following guarantees to assure quality patient care to medical beneficiaries:

(1) a Medicare Advantage patient shall have the right to see a duly licensed physician of the appropriate training and specialty;

(2) if CMS decertifies a Medicare Advantage plan, enrollees in that plan who are undergoing a course of treatment by a physician at the time of such termination shall continue to receive care from their treating physician until an appropriate transfer is accomplished; and

(3) any Medicare Advantage plan deselection of participating physicians may occur only after the physician has been given the opportunity to appeal the deselection decision to an Independent Review Body.

Policy Timeline 

Res. 707, I-98 Reaffirmed: BOT Rep. 23, A-09 Modified: CMS Rep. 01, A-19