List of MA/PD Decisions

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


Showing 1-10 of 40 entries
Decision Number Case Name Topic or Issue
2008 CD App. 01 Red Medica de Puerto Rico, Inc. - Initial Application Denial, H3420 Noncompliance with the MA-PD program.
2008 CD Apps. 04, 05 and 07 Arcadian Health Care Plan, Inc. - Service Area Expansion Application Denials, H4529, H5783 and H6497 Failure to submit proper documentation of its network access as required.
2010 CD App. 01 and Administrator's Review 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. 02 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. 03 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. 06 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. 07 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 Apps. 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 Apps. 13 and 14 Guardian Healthcare, Inc. - Denial of Applications H7341 & H9779 Adequacy of network, consistency of CMS exception process with the regulations; failure to consider materials received after the deadline of final submission of application; failure to provide evidence of fiscal solvency.
2010 CD Term 01 Fox Insurance Company - Immediate Termination of Prescription Drug Plan, Proof of imminent and serious risk to health; necessity to prove financial difficulties for immediate termination; date of substantial compliance under the regulation.
Page Last Modified:
07/11/2017 12:57 PM