FMA House of Delegates Endorses Rheumatology-Driven Resolution

FMA House of Delegates Endorses Rheumatology-Driven Resolution on Medicare Advantage Network Reductions

At its annual meeting in early August, the Florida Medical Association (FMA) adopted a significant resolution, championed by the South Florida Caucus and the Florida Society of Rheumatology (FSR), and developed by Dr. Shawn Baca. This resolution commits the FMA to sharing any research indicating that reductions in Medicare Advantage networks adversely affect patient care with the Centers for Medicare & Medicaid Services (CMS) and relevant CMS advisory boards overseeing insurance companies responsible for these network reductions. Dr. Robert Levin also highlighted the impacts of these network changes on both patients and providers during the meeting.

In late 2023, the FSR learned from various rheumatology practices that they had been removed from the Florida Blue Medicare Advantage Network. In response, FSR conducted a member survey to gather data and subsequently sent a formal letter to Florida representatives on the U.S. House Committee on Ways and Means, as well as to CMS Administrator Chiquita Brooks-LaSure. The letter informed Florida Blue of their breach of CMS’s network adequacy standards for Medicare Advantage.

Seeking further assistance, FSR reached out to the Coalition of State Rheumatology Organizations (CSRO) for support with CMS. Although a virtual meeting with CMS representatives followed, the outcome was a report from CMS affirming the network’s adequacy. FSR then arranged another meeting with the Medicare Payment Advisory Commission (MedPAC) to discuss potential solutions for the network adequacy issues faced by Florida rheumatologists.

FSR will keep members informed on the progress of the resolution’s objectives and any other developments related to network adequacy.