The Alliance of Specialty Medicine responded to the 2025 Medicare Advantage “Advance Notice,” urging the Centers for Medicare and Medicaid Services to make revisions to its network adequacy criteria and add new quality measures that focus on physician/plan interactions. In terms of network adequacy, the specialty coalition highlighted the increased rate of specialty physician terminations from plan networks and urged CMS to ensure all specialties and sub-specialties are subject to the time/distance requirements, including revisions to those already counted under this standard, as well as add appointment wait time standards for all specialties and subspecialties. They also asked that CMS require plans to make their “value metrics” transparent so that specialists understand the metrics on which plans are using to make network decisions.
With regard to the Quality Bonus Program, the Alliance asked CMS to adopt a Star Ratings measure that would focus on prior authorizations, and another based on a survey of physicians regarding their interactions with plans. The Alliance recommended that the survey focus on network adequacy, payment and reimbursement practices, contracting, utilization management, and other administrative burdens. The complete letter can be accesed by clicking the link below
Alliance Response to 2025 Advance Notice for Medicare Advantage
