Medicare Advantage/Prescription Drug Plan Decisions

  • List of MAPD Decisions

List of MAPD Decisions

List of selected CMS Hearing Officer Decisions on Medicare Advantage/ Prescription Drug Plan cases.

Decision Number Case Name Topic or Issue
2010 CD App 2 Citrus Health Care - Denial of Service Area Expansion Contract # H5407 Use of Star Rating System to deny applications for fiscal year 2011
2010 CD App 1 American Health Alliance, Inc. - Denial of Initial Application, H6037 Failure to make attestation; failure to complete application correctly (clearly define relationships between first tier, downstream and related entities)
2010 CD App 6 Piedmont Community HealthCare, Inc. - Denial of Initial Application, H1659 Adequacy of network concerning dialysis services; no exceptions for provider's refusal to contract
2010 CD App 3 Arkansas Blue Cross and Blue Shield - Denial of Initial Application, H8091 Adequacy of contract language concerning production of records by the plan or its contractors to CMS or other government entities
2010 CD App 7 Stonebridge Life Insurance Company, Inc. - Denial of Initial Application, S3502 Failure to include various contract provisions in all plan's contracts with first tier, downstream and related entities
2010 CD App 11 and 12 Universal Health Insurance Company, Inc. - Denial of Initial Applications, H8098 and H8319 Failure to complete correctly (adequacy of network concern travel distance and time to various providers); adequacy of CMS intent to deny notices; authority of Hearing Officer to sever service areas
2010 CD App 13 and 14 Guardian Healthcare, Inc. - Denial of Applications H7341 & H9779 Adequacy of network, consistancy of CMS exception process with the regulations; failure to consider materials recieved after the deadline of final submission of application; failure to provide evidence of fiscal solvency
2010 CD Term 1 Fox Insurance Company - Immediate Termination of Prescription Drug Plan, Proof of imminent and serious risk to health; necessity to prove finanial difficulties for immediate termination; date of substancial compliance under the regulation
2011 C/D App 1-10 United Healthcare Insurance Company Service Area Expansions and Initial Denials Denial of service area expansions and initial applications due to failure to comply with terms of a current or previous year's contract
2011 CD App 12 Senior Whole Health, LLC Denial of Service Area Expansion Lack of appropriate state licensure