CMS proposed new behavioral network adequacy standards for Medicare Advantage plans, but some groups are concerned there aren't enough providers to meet them.
In a comment letter sent to CMS Jan. 5 the American Hospital Association said some communities may not be able to meet CMS' standards in 2025.
"While we believe it is still important to finalize these proposals, as we expect they will contribute to a more favorable environment for behavioral health care providers to participate in plan networks, we urge CMS to develop mechanisms to waive or otherwise make exceptions to these rules in markets where plans acting in good faith still cannot contract with the full spectrum of providers," the association said in its letter.
In its proposed 2025 rules for Medicare Advantage, published Nov. 6, the agency pitched requiring network adequacy standards for outpatient behavioral health providers, including marriage and family therapists, mental health counselors, and addiction or drug and alcohol counselors.
In a comment letter to CMS sent Jan. 3, the Alliance of Community Health Plans urged CMS to up bonus payments for plans' in-network telehealth providers and allow telehealth wait times to count toward appointment wait-time requirements.