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        <generator>Centers for Medicare and Medicaid Services</generator><item><title>2023 H-23-00022</title><pubDate>Mon, 22 Jan 2024 15:47:15 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00022</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00022</guid><description><![CDATA[<p>case_name: Sonder Health Plans, Inc.</p><p>decision_number: 2023 H-23-00022</p><p>topic: Network Deficiency (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00019 and Administrator's Review</title><pubDate>Mon, 22 Jan 2024 15:42:45 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00019-and-administrators-review</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00019-and-administrators-review</guid><description><![CDATA[<p>case_name: Longevity Health Plan of North Carolina, Inc.</p><p>decision_number: 2023 H-23-00019 and Administrator's Review</p><p>topic: Network Deficiency; Exception Request (with Administrator's Review)</p>]]></description></item><item><title>2023 H-23-00018 and Administrator's Review</title><pubDate>Mon, 22 Jan 2024 15:37:58 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00018-and-administrators-review</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00018-and-administrators-review</guid><description><![CDATA[<p>case_name: Longevity Health Plan of Michigan, Inc.</p><p>decision_number: 2023 H-23-00018 and Administrator's Review</p><p>topic: Network Deficiency; Exception Request (with Administrator's Review)</p>]]></description></item><item><title>2023 H-23-00017</title><pubDate>Mon, 22 Jan 2024 15:32:23 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00017</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00017</guid><description><![CDATA[<p>case_name: Molina Healthcare of Nebraska, Inc.</p><p>decision_number: 2023 H-23-00017</p><p>topic: Past Performance; Network Deficiency (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00016</title><pubDate>Mon, 22 Jan 2024 15:28:26 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00016</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00016</guid><description><![CDATA[<p>case_name: Molina Healthcare of Indiana, Inc.</p><p>decision_number: 2023 H-23-00016</p><p>topic: Past Performance; Network Deficiency (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00012</title><pubDate>Mon, 22 Jan 2024 14:50:23 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00012</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00012</guid><description><![CDATA[<p>case_name: Zing Health, Inc.</p><p>decision_number: 2023 H-23-00012</p><p>topic: Licensure; Past Performance; Star Ratings; Letters of Intent (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00011</title><pubDate>Mon, 22 Jan 2024 14:30:57 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00011</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00011</guid><description><![CDATA[<p>case_name: Lasso Healthcare Insurance Company</p><p>decision_number: 2023 H-23-00011</p><p>topic: Past Performance; Star Ratings (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00008</title><pubDate>Mon, 22 Jan 2024 14:27:36 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00008</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00008</guid><description><![CDATA[<p>case_name: Provider Partners Health Plan of North Carolina</p><p>decision_number: 2023 H-23-00008</p><p>topic: Letters of Intent (no request for Administrator review)</p>]]></description></item><item><title>2023 H-23-00007</title><pubDate>Mon, 22 Jan 2024 14:24:52 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00007</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00007</guid><description><![CDATA[<p>case_name: HealthSpring Life &#x26; Health Insurance</p><p>decision_number: 2023 H-23-00007</p><p>topic: Novation; Exception Requests; Network Deficiency; Letters of Intent (no request for Administrator review)</p>]]></description></item><item><title>2023 H-23-00005</title><pubDate>Mon, 22 Jan 2024 14:21:47 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00005</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00005</guid><description><![CDATA[<p>case_name: VNS Choice Health Plan</p><p>decision_number: 2023 H-23-00005</p><p>topic: Network Deficiency; Letters of Intent (no request for Administrator review)</p>]]></description></item><item><title>2023 H-23-00004</title><pubDate>Mon, 22 Jan 2024 14:01:33 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00004</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00004</guid><description><![CDATA[<p>case_name: Chinese Community Health Plan</p><p>decision_number: 2023 H-23-00004</p><p>topic: Network Deficiency (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00003</title><pubDate>Mon, 22 Jan 2024 13:58:00 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00003</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00003</guid><description><![CDATA[<p>case_name: Verda Health Plan of Texas, Inc.</p><p>decision_number: 2023 H-23-00003</p><p>topic: Licensure; Network Deficiency (Administrator declined review)</p>]]></description></item><item><title>2023 H-23-00002</title><pubDate>Mon, 22 Jan 2024 13:50:45 -0500</pubDate><link>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00002</link><guid>https://www.cms.gov//medicare/regulations-guidance/cms-hearing-officer/medicare-advantage-prescription-drug-plan-appeals/2023-h-23-00002</guid><description><![CDATA[<p>case_name: Imperial Health Plan of California</p><p>decision_number: 2023 H-23-00002</p><p>topic: Contract Termination; Star Ratings (Administrator declined review)</p>]]></description></item><item><title>2022 H-22-00016</title><pubDate>Wed, 25 Jan 2023 16:14:41 -0500</pubDate><link>https://www.cms.gov//regulations-guidance/review-boards/cms-hearing-officer/ma-pd-plan-appeals/2022-h-22-00016</link><guid>https://www.cms.gov//regulations-guidance/review-boards/cms-hearing-officer/ma-pd-plan-appeals/2022-h-22-00016</guid><description><![CDATA[<p>case_name: Vitality Health Plan of California</p><p>decision_number: 2022 H-22-00016</p><p>topic: Past Performance</p>]]></description></item><item><title>2022 H-22-00015</title><pubDate>Wed, 25 Jan 2023 16:11:34 -0500</pubDate><link>https://www.cms.gov//regulations-guidance/review-boards/cms-hearing-officer/ma-pd-plan-appeals/2022-h-22-00015</link><guid>https://www.cms.gov//regulations-guidance/review-boards/cms-hearing-officer/ma-pd-plan-appeals/2022-h-22-00015</guid><description><![CDATA[<p>case_name: Reliance HMO, Inc.</p><p>decision_number: 2022 H-22-00015</p><p>topic: Past Performance</p>]]></description></item><item><title>2022 H-22-00014 and Administrator's Review</title><pubDate>Wed, 25 Jan 2023 16:08:04 -0500</pubDate><link>https://www.cms.gov//regulations-guidance/review-boards/cms-hearing-officer/ma-pd-plan-appeals/2022-h-22-00014-and-administrators-review</link><guid>https://www.cms.gov//regulations-guidance/review-boards/cms-hearing-officer/ma-pd-plan-appeals/2022-h-22-00014-and-administrators-review</guid><description><![CDATA[<p>case_name: Renal Payer Solutions, Inc.</p><p>decision_number: 2022 H-22-00014 and Administrator's Review</p><p>topic: Licensure</p>]]></description></item><item><title>2021 H-21-0015</title><pubDate>Wed, 08 Dec 2021 14:58:20 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0015</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0015</guid><description><![CDATA[<p>case_name: Leon Health Plans, Inc.</p><p>decision_number: 2021 H-21-0015</p><p>topic: Contracting</p>]]></description></item><item><title>2021 H-21-0013 and H-21-0014 and Administrator's Review</title><pubDate>Wed, 08 Dec 2021 14:54:26 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0013-and-h-21-0014-and-administrators-review</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0013-and-h-21-0014-and-administrators-review</guid><description><![CDATA[<p>case_name: eternalHealth, Inc.</p><p>decision_number: 2021 H-21-0013 and H-21-0014 and Administrator's Review</p><p>topic: Contracting (with Administrator's Review)</p>]]></description></item><item><title>2021 H-21-0011</title><pubDate>Wed, 08 Dec 2021 14:36:52 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0011</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0011</guid><description><![CDATA[<p>case_name: Community Insurance Company</p><p>decision_number: 2021 H-21-0011</p><p>topic: Contracting</p>]]></description></item><item><title>2021 H-21-0009 and Administrator's Review</title><pubDate>Wed, 08 Dec 2021 14:33:10 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0009-and-administrators-review</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0009-and-administrators-review</guid><description><![CDATA[<p>case_name: Essence Healthcare, Inc.</p><p>decision_number: 2021 H-21-0009 and Administrator's Review</p><p>topic: Licensure (with Administrator's Review)</p>]]></description></item><item><title>2021 H-21-0006</title><pubDate>Wed, 08 Dec 2021 14:24:18 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0006</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2021-h-21-0006</guid><description><![CDATA[<p>case_name: Exemplar Health Insurance Company, Inc.</p><p>decision_number: 2021 H-21-0006</p><p>topic: Licensure/Waiver Applications</p>]]></description></item><item><title>2020 MAPD App. 15-21</title><pubDate>Thu, 18 Mar 2021 11:55:51 -0400</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2020-mapd-app-15-21</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2020-mapd-app-15-21</guid><description><![CDATA[<p>case_name: Centene Venture Company</p><p>decision_number: 2020 MAPD App. 15-21</p><p>topic: Agency adherence to deficiency notification requirements; definition and documentation of relationships with first tier, downstream and related entities; adequacy of contract payment terms.</p>]]></description></item><item><title>2020 MAPD App. 09</title><pubDate>Thu, 18 Mar 2021 11:49:23 -0400</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2020-mapd-app-09</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardscms-hearing-officerlist-ma-pd-decisions/2020-mapd-app-09</guid><description><![CDATA[<p>case_name: Meridian Health Plan of Michigan</p><p>decision_number: 2020 MAPD App. 09</p><p>topic: Definition and documentation of relationships with first tier, downstream and related entities; consideration of materials received after the deadline of final submission of application.</p>]]></description></item><item><title>2019 MAPD App. 08</title><pubDate>Fri, 10 Apr 2020 12:37:08 -0400</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-08</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-08</guid><description><![CDATA[<p>case_name: Constellation Health, LLC</p><p>decision_number: 2019 MAPD App. 08</p><p>topic: Termination - Authorized Official Lack of Standing</p>]]></description></item><item><title>2019 MAPD App. 07</title><pubDate>Fri, 10 Apr 2020 12:25:55 -0400</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-07</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-07</guid><description><![CDATA[<p>case_name: Provider Partners Health Plan of Missouri, Inc.</p><p>decision_number: 2019 MAPD App. 07</p><p>topic: Contracting</p>]]></description></item><item><title>2019 MAPD App. 05</title><pubDate>Fri, 10 Apr 2020 12:15:47 -0400</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-05</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-05</guid><description><![CDATA[<p>case_name: Prominence Health First of Florida, Inc.</p><p>decision_number: 2019 MAPD App. 05</p><p>topic: Licensure</p>]]></description></item><item><title>2019 MAPD App. 01</title><pubDate>Fri, 10 Apr 2020 11:22:34 -0400</pubDate><link>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-01</link><guid>https://www.cms.gov//regulations-and-guidancereview-boardsmedicare-advantage-prescription-drug-plan-decisionslist-ma-pd/2019-mapd-app-01</guid><description><![CDATA[<p>case_name: Texas Independence Health Plan, Inc.</p><p>decision_number: 2019 MAPD App. 01</p><p>topic: Failure to File Timely Application</p>]]></description></item><item><title>2018 MAPD App. 08, 09 and 10</title><pubDate>Mon, 04 Nov 2019 02:47:54 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_apps_8-9-and-10</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_apps_8-9-and-10</guid><description><![CDATA[<p>case_name: Constellation Health, LLC</p><p>decision_number: 2018 MAPD App. 08, 09 and 10</p><p>topic: State Licensure</p>]]></description></item><item><title>2018 MAPD App. 03 and 05</title><pubDate>Mon, 04 Nov 2019 02:47:49 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_apps_3-and-5</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_apps_3-and-5</guid><description><![CDATA[<p>case_name: Bright Health Insurance Company of New York, Inc.</p><p>decision_number: 2018 MAPD App. 03 and 05</p><p>topic: State Licensure</p>]]></description></item><item><title>2018 MAPD App. 06</title><pubDate>Mon, 04 Nov 2019 02:47:49 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_6</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_6</guid><description><![CDATA[<p>case_name: HealthSpring Life and Health Insurance Company</p><p>decision_number: 2018 MAPD App. 06</p><p>topic: Two Year Contracting Prohibition - Non-Renewal</p>]]></description></item><item><title>2018 MAPD App. 04</title><pubDate>Mon, 04 Nov 2019 02:47:49 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_4</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_4</guid><description><![CDATA[<p>case_name: Legacy Health Plan, Inc.</p><p>decision_number: 2018 MAPD App. 04</p><p>topic: State Licensure</p>]]></description></item><item><title>2018 MAPD App. 11, 12, 13 and 14</title><pubDate>Mon, 04 Nov 2019 02:47:48 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_apps_11-12-13-and-14</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_apps_11-12-13-and-14</guid><description><![CDATA[<p>case_name: Anthem, Inc.</p><p>decision_number: 2018 MAPD App. 11, 12, 13 and 14</p><p>topic: Past Performance</p>]]></description></item><item><title>2018 MAPD App. 02</title><pubDate>Mon, 04 Nov 2019 02:47:48 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_2</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_2</guid><description><![CDATA[<p>case_name: Longevity Health Plan of New Jersey Insurance Company, Inc.</p><p>decision_number: 2018 MAPD App. 02</p><p>topic: Application - Legal Entity</p>]]></description></item><item><title>2018 MAPD App. 01</title><pubDate>Mon, 04 Nov 2019 02:47:48 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_1</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2018_mapd_app_1</guid><description><![CDATA[<p>case_name: Golden Cross Health Plan Corp.</p><p>decision_number: 2018 MAPD App. 01</p><p>topic: Jurisdiction/Nullification</p>]]></description></item><item><title>2017 MAPD App. 10</title><pubDate>Mon, 04 Nov 2019 02:44:42 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_10</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_10</guid><description><![CDATA[<p>case_name: Blue Cross and Blue Shield of Michigan</p><p>decision_number: 2017 MAPD App. 10</p><p>topic: Failure to meet health services management and delivery application requirement.</p>]]></description></item><item><title>2017 MAPD App. 04</title><pubDate>Mon, 04 Nov 2019 02:44:35 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_04</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_04</guid><description><![CDATA[<p>case_name: Universal Care, Inc.</p><p>decision_number: 2017 MAPD App. 04</p><p>topic: Failure to Provide State Approval for d/b/a.</p>]]></description></item><item><title>2017 MAPD App. 09</title><pubDate>Mon, 04 Nov 2019 02:44:35 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_09</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_09</guid><description><![CDATA[<p>case_name: Health Advantage Florida, Inc.</p><p>decision_number: 2017 MAPD App. 09</p><p>topic: Lack of Appropriate State License.</p>]]></description></item><item><title>2017 MAPD App. 03</title><pubDate>Mon, 04 Nov 2019 02:44:33 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_03</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2017_mapd_app_03</guid><description><![CDATA[<p>case_name: Bright Health Company of New York, Inc.</p><p>decision_number: 2017 MAPD App. 03</p><p>topic: Lack of Appropriate State Licensure.</p>]]></description></item><item><title>2016 MA/PD App. 04</title><pubDate>Mon, 04 Nov 2019 02:42:53 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_04</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_04</guid><description><![CDATA[<p>case_name: Boston Medical Center Health Plan</p><p>decision_number: 2016 MA/PD App. 04</p><p>topic: Denial of service area expansion on basis that Applicant lacked 14 months of performance history.</p>]]></description></item><item><title>2016 MA/PD App. 06</title><pubDate>Mon, 04 Nov 2019 02:42:51 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_06</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_06</guid><description><![CDATA[<p>case_name: Anthem - BCBSA of California</p><p>decision_number: 2016 MA/PD App. 06</p><p>topic: Adequacy of network; application process.</p>]]></description></item><item><title>2016 MA/PD App. 03</title><pubDate>Mon, 04 Nov 2019 02:42:50 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_03</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_03</guid><description><![CDATA[<p>case_name: United Health Group, Inc. UHC of California</p><p>decision_number: 2016 MA/PD App. 03</p><p>topic: Adequacy of network; application process.</p>]]></description></item><item><title>2016 MA/PD App. 05</title><pubDate>Mon, 04 Nov 2019 02:42:50 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_05</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2016_mapd_app_05</guid><description><![CDATA[<p>case_name: Viventum Health Plan </p><p>decision_number: 2016 MA/PD App. 05</p><p>topic: State licensure.</p>]]></description></item><item><title>2015 MA/PD App. 02</title><pubDate>Mon, 04 Nov 2019 02:40:49 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2015_mapd_app_02</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2015_mapd_app_02</guid><description><![CDATA[<p>case_name: Sanford Heart of America Health Plan</p><p>decision_number: 2015 MA/PD App. 02</p><p>topic: Adequacy of network.</p>]]></description></item><item><title>2015 MA/PD App. 01 and Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:40:38 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2015_mapd_app_01</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2015_mapd_app_01</guid><description><![CDATA[<p>case_name: Provider Partners Health Plan</p><p>decision_number: 2015 MA/PD App. 01 and Administrator's Review</p><p>topic: Adequacy of network.</p>]]></description></item><item><title>2015 MA/PD App. 03 and Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:40:38 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2015_mapd_app_03</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2015_mapd_app_03</guid><description><![CDATA[<p>case_name: Eden Health Plan</p><p>decision_number: 2015 MA/PD App. 03 and Administrator's Review</p><p>topic: State licensure; fiscal solvency.</p>]]></description></item><item><title>2008 CD Apps. 04, 05 and 07</title><pubDate>Mon, 04 Nov 2019 02:40:12 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2008_cd_app_04_05_and_07</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2008_cd_app_04_05_and_07</guid><description><![CDATA[<p>case_name: Arcadian Health Care Plan, Inc. - Service Area Expansion Application Denials, H4529, H5783 and H6497</p><p>decision_number: 2008 CD Apps. 04, 05 and 07</p><p>topic: Failure to submit proper documentation of its network access as required.</p>]]></description></item><item><title>2008 CD App. 01</title><pubDate>Mon, 04 Nov 2019 02:40:11 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2008_cd_app_01</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2008_cd_app_01</guid><description><![CDATA[<p>case_name: Red Medica de Puerto Rico, Inc. - Initial Application Denial, H3420</p><p>decision_number: 2008 CD App. 01</p><p>topic: Noncompliance with the MA-PD program.</p>]]></description></item><item><title>2014 MA/PD Apps. 10 and 11</title><pubDate>Mon, 04 Nov 2019 02:39:11 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2014_mapd_app_10_and_11</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2014_mapd_app_10_and_11</guid><description><![CDATA[<p>case_name: WellCare Health Plans of New Jersey, Inc. - Denial of Initial Application, H1587</p><p>decision_number: 2014 MA/PD Apps. 10 and 11</p><p>topic: Assessment of Negative Performance Points</p>]]></description></item><item><title>2014 MA/PD Apps. 06 and 07 with Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:38:33 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2014_mapd_app_06_and_07</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2014_mapd_app_06_and_07</guid><description><![CDATA[<p>case_name: Harvard Pilgrim Health Care, Inc. (HPHC)</p><p>decision_number: 2014 MA/PD Apps. 06 and 07 with Administrator's Review</p><p>topic: Denial of service area expansion on basis that Applicant lacked 14 months performance history.</p>]]></description></item><item><title>2014 MA/PD App. 02</title><pubDate>Mon, 04 Nov 2019 02:38:32 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2014_mapd_app_02</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2014_mapd_app_02</guid><description><![CDATA[<p>case_name: Arkansas Superior Select, Inc. - Denial of Initial Application, H1587</p><p>decision_number: 2014 MA/PD App. 02</p><p>topic: Application Process</p>]]></description></item><item><title>2013 MA/PD App. 10</title><pubDate>Mon, 04 Nov 2019 02:37:15 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_10</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_10</guid><description><![CDATA[<p>case_name: University Care Advantage, LLC – Denial of Application H7352</p><p>decision_number: 2013 MA/PD App. 10</p><p>topic: Adequacy of network; consistency of CMS exception process with the regulations; consideration of materials received after the deadline of final submission of application.</p>]]></description></item><item><title>2013 MA/PD App. 06</title><pubDate>Mon, 04 Nov 2019 02:37:10 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_06</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_06</guid><description><![CDATA[<p>case_name: Gateway Health Plan of Ohio, Inc. – Denial of Application H9190</p><p>decision_number: 2013 MA/PD App. 06</p><p>topic: Agency adherence to deficiency notification requirements; definition and documentation of relationships with first tier, downstream and related entities.</p>]]></description></item><item><title>2013 MA/PD Apps. 08 and 11 with Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:37:10 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_08_and_11</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_08_and_11</guid><description><![CDATA[<p>case_name: MedStar Family Choice, Inc. SAE and SNP – Denial of Application H9915</p><p>decision_number: 2013 MA/PD Apps. 08 and 11 with Administrator's Review</p><p>topic: Duration of sponsor performance history; plan product offerings; impact of erroneous conditional approval on final outcome; materiality of disputed facts.</p>]]></description></item><item><title>2013 MA/PD App. 05 with Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:37:10 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_05</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_05</guid><description><![CDATA[<p>case_name: Blue Cross Blue Shield of Montana, Inc. – Denial of Application H0107</p><p>decision_number: 2013 MA/PD App. 05 with Administrator's Review</p><p>topic: Agency adherence to deficiency notification requirements;  definition and documentation of relationships with first tier, downstream and related entities; adequacy of contract payment terms.</p>]]></description></item><item><title>2013 MA/PD App. 07 with Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:37:09 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_07</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_07</guid><description><![CDATA[<p>case_name: Community Care Alliance of Illinois ? Denial of Application H3071</p><p>decision_number: 2013 MA/PD App. 07 with Administrator's Review</p><p>topic: Lack of appropriate state licensure at time of application; consideration of materials received after the deadline of final submission of application.</p>]]></description></item><item><title>2013 MA/PD App. 03</title><pubDate>Mon, 04 Nov 2019 02:37:09 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_03</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_03</guid><description><![CDATA[<p>case_name: Moda Health Plan, Inc. – Denial of Application H1307</p><p>decision_number: 2013 MA/PD App. 03</p><p>topic: Adequacy of network; consistency of CMS exception process with the regulations; consideration of materials received after the deadline of final submission of application.</p>]]></description></item><item><title>2013 MA/PD App. 02</title><pubDate>Mon, 04 Nov 2019 02:37:07 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_02</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2013_mapd_app_02</guid><description><![CDATA[<p>case_name: Vantage Health Plan of Arkansas, Inc. – Denial of Application H6380</p><p>decision_number: 2013 MA/PD App. 02</p><p>topic: Definition and documentation of relationships with first tier, downstream and related entities; consideration of materials received after the deadline of final submission of application.</p>]]></description></item><item><title>2011 CD Apps. 01 thru 10 with Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:31:37 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2011_cd_app_01_through_10</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2011_cd_app_01_through_10</guid><description><![CDATA[<p>case_name: United Healthcare Insurance Company Service Area Expansions and Initial Denials</p><p>decision_number: 2011 CD Apps. 01 thru 10 with Administrator's Review</p><p>topic: Denial of service area expansions and initial applications due to failure to comply with terms of a current or previous year's contract.</p>]]></description></item><item><title>2011 CD App. 12 with Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:31:33 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2011_cd_app_12</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2011_cd_app_12</guid><description><![CDATA[<p>case_name: Senior Whole Health, LLC Denial of Service Area Expansion</p><p>decision_number: 2011 CD App. 12 with Administrator's Review</p><p>topic: Lack of appropriate state licensure</p>]]></description></item><item><title>2010 CD App. 07</title><pubDate>Mon, 04 Nov 2019 02:26:33 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_07</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_07</guid><description><![CDATA[<p>case_name: Stonebridge Life Insurance Company, Inc. - Denial of Initial Application, S3502</p><p>decision_number: 2010 CD App. 07</p><p>topic: Failure to include various contract provisions in all plan's contracts with first tier, downstream and related entities.</p>]]></description></item><item><title>2010 CD Apps. 13 and 14</title><pubDate>Mon, 04 Nov 2019 02:26:33 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_13_and_14</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_13_and_14</guid><description><![CDATA[<p>case_name: Guardian Healthcare, Inc. - Denial of Applications H7341 &#x26; H9779</p><p>decision_number: 2010 CD Apps. 13 and 14</p><p>topic: 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.</p>]]></description></item><item><title>2010 CD Apps. 11 and 12</title><pubDate>Mon, 04 Nov 2019 02:26:27 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_11_and_12</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_11_and_12</guid><description><![CDATA[<p>case_name: Universal Health Insurance Company, Inc. - Denial of Initial Applications, H8098 and H8319</p><p>decision_number: 2010 CD Apps. 11 and 12</p><p>topic: 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.</p>]]></description></item><item><title>2010 CD App. 02</title><pubDate>Mon, 04 Nov 2019 02:26:27 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_02</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_02</guid><description><![CDATA[<p>case_name: Citrus Health Care - Denial of Service Area Expansion Contract # H5407</p><p>decision_number: 2010 CD App. 02</p><p>topic: Use of Star Rating System to deny applications for fiscal year 2011.</p>]]></description></item><item><title>2010 CD Term 01</title><pubDate>Mon, 04 Nov 2019 02:26:27 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_term_01</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_term_01</guid><description><![CDATA[<p>case_name: Fox Insurance Company - Immediate Termination of Prescription Drug Plan,</p><p>decision_number: 2010 CD Term 01</p><p>topic: Proof of imminent and serious risk to health; necessity to prove financial difficulties for immediate termination; date of substantial compliance under the regulation.</p>]]></description></item><item><title>2010 CD App. 01 and Administrator's Review</title><pubDate>Mon, 04 Nov 2019 02:26:27 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_01</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_01</guid><description><![CDATA[<p>case_name: American Health Alliance, Inc. - Denial of Initial Application, H6037</p><p>decision_number: 2010 CD App. 01 and Administrator's Review</p><p>topic: Failure to make attestation; failure to complete application correctly (clearly define relationships between first tier, downstream and related entities).</p>]]></description></item><item><title>2010 CD App. 03</title><pubDate>Mon, 04 Nov 2019 02:26:26 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_03</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_03</guid><description><![CDATA[<p>case_name: Arkansas Blue Cross and Blue Shield - Denial of Initial Application, H8091</p><p>decision_number: 2010 CD App. 03</p><p>topic: Adequacy of contract language concerning production of records by the plan or its contractors to CMS or other government entities.</p>]]></description></item><item><title>2010 CD App. 06</title><pubDate>Mon, 04 Nov 2019 02:26:26 -0500</pubDate><link>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_06</link><guid>https://www.cms.gov//regulations-and-guidance/review-boards/medicare-advantage-prescription-drug-plan-decisions/list-of-mapd-decisions-items/2010_cd_app_06</guid><description><![CDATA[<p>case_name: Piedmont Community HealthCare, Inc. - Denial of Initial Application, H1659</p><p>decision_number: 2010 CD App. 06</p><p>topic: Adequacy of network concerning dialysis services; no exceptions for provider's refusal to contract.</p>]]></description></item></channel></rss>