Coverage throughout the State

40.1 - Coverage throughout the State (Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13) If an MAO provides coverage to individuals in any part of a State, CMS is waiving the requirement that the Individual Employer Group Health Plans and EGWPs have the same service area. Accordingly, under this waiver, an MAO offering an individual MA plan in a state can offer an EGWP (of the same plan type) in any area within that State or throughout the entire State (provided the EGWP service area is properly requested and defined in HPMS). For Part C benefits, the MAO is responsible for ensuring that CMS provider network adequacy requirements are met and that consistent benefits are provided to the employer/union group plan sponsor’s enrollees.