Summer 2009

Have you returned the contract amendments that include new CMS language requirements?

Providers who participate in our Medicare Advantage networks should have recently received contract amendments containing updated Centers for Medicare & Medicaid Services (CMS) language requirements for the provider agreement.

CMS updated and clarified its requirements that Medicare Advantage (MA) Organizations and Medicare Part D sponsors have certain language in plan contracts between providers and vendors who render health care and/or administrative services to MA and/or Part D beneficiaries (first tier or downstream, by CMS definitions). The final rules for plan contracts were published in the Federal Register on Dec. 5, 2007, and are codified into law for MA Organizations in 42 CFR 422 and for Part D Sponsors in 42 CFR 423.

The entire amendment to the provider agreement should be signed and returned to Blue Cross and Blue Shield of Florida/Health Options as soon as possible, as indicated in the instructions furnished in the original communication. The amendments will be countersigned and a copy will be returned to you.

Providers with questions about CMS’s language requirements can call our Network Management Service Unit at (800) 727-2227, say “More Choices,” then “Network Management.” To review the final rules published in the Federal Register, go to http://edocket.access.gpo.gov/2007/pdf/07-5946.pdf.