CMS is suspending enrollment for a Maryland Medicare Advantage institutional special needs plan operated by Provider Partners Health Plans after the insurer lost all contracted long-term care facilities in the plan’s network and then disenrolled some members without their consent.
In a May 29 letter, CMS said the insurer had lost all contractual relationships with its long-term care facilities by the end of 2025. Some facilities declined to renew contracts with the plan, while the insurer chose to terminate contracts with others.
Rather than reporting the network failures to CMS, Provider Partners sent notices to its members incorrectly saying they had lost their special needs status. Those beneficiaries remained institutionalized in the same long-term care facilities. While some enrollees voluntarily enrolled into other plans, Provider Partners involuntarily disenrolled 29 of them from the program, citing the loss of their program status.
“PPHP took a series of improper actions that harmed its enrollees,” CMS wrote. “After considering the seriousness of the noncompliance, CMS has determined that enrollment suspension is necessary and proportionate to protect enrollees and the integrity of the Medicare Advantage program.”
The intermediate sanction is effective June 14 and will remain until the issues have been corrected and likely won’t happen again. Provider Partners Health Plans has 9,000 members and also operates I-SNPs in Illinois, Missouri, Ohio, North Carolina, Pennsylvania and Texas, per its website; those contracts are not affected by the sanction.
CMS previously sent violation letters to Provider Partners in 2019 and 2022 over network adequacy gaps in its Ohio plan.
Becker’s has reached out to Provider Partners and will update this article if more information becomes available.
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