Medicare Managed Care Manual (Pub. 100-16), Ch. 17f § 120.3
Provider Adequacy
120.3 - Provider Adequacy
(Rev. 77, Issued: 10-28-05, Effective Date: 10-28-05)
The provider networks for Medicare enrollees must be sufficient to deliver both:
•
Inpatient; and
•
Outpatient services;
for both:
•
Primary; and
•
Specialty services;
to both:
•
Current; and
•
Expected Medicare members.
The obligation on the Medicare cost plan to provide services remains even if there is a
loss of providers in a portion of the geographic area. Medicare cost plans must inform
members, in writing, 30 days before a physician or supplier terminates affiliation.