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A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a state licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide. One major difference between a PFFS Medicare Advantage Organization (MAO) and other MAOs is that, in most cases, people who join a PFFS MAO are not required to use a network of providers. Beneficiaries can see any provider who is eligible to receive payment from Medicare and agrees to accept payment from the PFFS MAO. On January 19, 2010, CMS released guidance titled "Transition of Private Fee-for-Service Contractors to Network-Based Access Requirements" that updated the list of network areas for non-employer PFFS plans for contract year 2011. The updated list of network areas for contract year 2011, the list of 601 counties that were removed from the list that was previously released with the 2010 Advance Notice and 2010 Announcement, and the list of network areas for contract year 2012, can be downloaded from below.
Page Last Modified: 04/12/2010 10:33:35 AM
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