This bill requires Medicare Advantage insurance plans to include essential community providers—such as federally qualified health centers, rural hospitals, mental health facilities, and providers serving low-income and underserved populations—in their provider networks. Plans must offer contracts to all available essential community providers in their service areas and maintain sufficient geographic distribution to ensure low-income individuals, rural residents, and those in health professional shortage areas have reasonable access to these providers. If a Medicare Advantage plan cannot meet these requirements, the insurance company must submit a detailed explanation to the federal government explaining why and how it will work toward compliance by the next plan year; plans with insufficient justifications will not be approved. The bill also requires Medicare Advantage plans to pay federally qualified health centers consistent with existing payment rates. This legislation affects Medicare Advantage enrollees, particularly vulnerable populations in underserved areas, and the health centers and hospitals that serve them.
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