Free Network Build Assessment
Take it freeCMS adequacy standards require health plans to meet specific time-distance thresholds for every county in their service area — across 22 HSD specialty categories for Medicare Advantage, and similar standards for Medicaid and Exchange builds. These guides break down how the standards work, how gaps are measured, and what it actually takes to pass.
CMS has tightened time-and-distance standards for Medicare Advantage plans over the past three benefit years. Here's what changed, what's coming, and how network ops teams should prepare their builds.
Adequacy and access are often used interchangeably, but they measure different things — and failing one doesn't always mean failing the other. Understanding the distinction is critical for network ops teams managing CMS filings.
The HSD Reference File is the authoritative document CMS uses to set time-distance thresholds for Medicare Advantage network adequacy. Here's exactly what it contains, how to read it, and how Blueprint loads it automatically.
When a rural county lacks enough providers to meet CMS thresholds, a good-faith effort waiver can protect your filing. Here's what CMS requires and how to document it correctly.
Telehealth's role in CMS network adequacy calculations has evolved significantly — but the rules are more restrictive than many plans assume. This guide clarifies exactly which telehealth arrangements satisfy adequacy standards and which do not.
Dual Eligible Special Needs Plans face network adequacy requirements that layer D-SNP-specific standards on top of standard Medicare Advantage rules. New plan teams need to understand where the requirements differ — and where the stakes are higher.
The time-and-distance standard that applies to any given county depends entirely on how CMS classifies that county: urban, suburban, rural, or frontier. Getting this classification right — and challenging incorrect classifications — is fundamental to accurate adequacy modeling.
Geographic analysis is the foundation of a defensible adequacy filing. Here's how network teams use GIS-style analysis to find gaps, prioritize recruitment, and document their coverage story.
CMS time-distance standards are calculated against the nearest available in-network provider — but 'nearest' and 'available' have specific definitions that vary by county type. Here's how the calculation actually works.
CMS time-distance standards are calculated from member population centroids — not county centers. Networks built without understanding member geographic distribution fail adequacy tests that county-center analysis would have passed.
Counties with HRSA Health Professional Shortage Area (HPSA) designations present unique adequacy challenges — and specific regulatory accommodations. Here's how HPSA status affects your network build and your exception filings.
CMS applies four distinct sets of time-distance standards based on county classification. Understanding which standards apply where — and how county boundaries interact with member population — is the foundation of every accurate adequacy calculation.
Primary care is the foundation of Medicare Advantage network adequacy — and the most complex to build correctly. Here's how CMS evaluates PCP adequacy, how panel capacity affects your counts, and how to sequence recruitment to avoid last-minute gaps.
CMS has specific rules for when a provider counts toward network adequacy — open panel status, accepting-new-patients verification, and capacity thresholds all matter. Here's the complete operational guide for network teams building compliant provider rosters.
CMS requires Medicare Advantage plans to demonstrate adequacy across more than a dozen specialist categories, each with its own time-and-distance standard by county type. Here's the comprehensive guide to specialty adequacy strategy, subspecialty counting, and exception management.
CMS codified specific telehealth counting rules in the 2024 Final Rule that resolve years of ambiguity — but the rules are more nuanced than they first appear. Here's exactly which specialties qualify, what documentation is required, and how telehealth counting interacts with geographic exceptions.