List of Medicare Advantage/Prescription Drug Plan Decisions

Medicare Advantage ("MA") and Prescription Drug ("PD") Plans are permitted to participate in the Medicare Program under Sections 1857 and 1860D-12 of the Social security Act and regulations at 42 C.F.R. §§ 422.500 and 423.500 et seq. If the Centers for Medicare & Medicaid Services ("CMS") denies an application to qualify as an MA or PD Plan or takes adverse action (termination, non-renewal, intermediate sanction) against an existing MA or PD Plan, the applicant or existing MA or PD Plan is entitled to request a hearing before a CMS Hearing Officer, (42 C.F.R. §§ 422.660 and 423.650 et seq.) Additionally, the CMS Hearing Officer's decisions may be reviewed by the CMS Administrator in accordance with 42 C.F.R. §§ 423.666 and 422.690. Below is a list of selected decisions for MA/PD cases.


Showing 1-10 of 40 entries
Decision Number Case Name Topic or Issue
2018 MAPD App. 11, 12, 13 and 14 Anthem, Inc. Past Performance
2018 MAPD App. 08, 09 and 10 Constellation Health, LLC State Licensure
2018 MAPD App. 06 HealthSpring Life and Health Insurance Company Two Year Contracting Prohibition - Non-Renewal
2018 MAPD App. 04 Legacy Health Plan, Inc. State Licensure
2018 MAPD App. 03 and 05 Bright Health Insurance Company of New York, Inc. State Licensure
2018 MAPD App. 02 Longevity Health Plan of New Jersey Insurance Company, Inc. Application - Legal Entity
2018 MAPD App. 01 Golden Cross Health Plan Corp. Jurisdiction/Nullification
2017_MAPD_App_10 Blue Cross and Blue Shield of Michigan Failure to meet health services management and delivery application requirement.
2017_MAPD_App_09 Health Advantage Florida, Inc. Lack of Appropriate State License.
2017_MAPD_App_04 Universal Care, Inc. Failure to Provide State Approval for d/b/a.
Page Last Modified:
01/13/2020 09:40 PM