Effective January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) will revise contractual regulations 42 CFR ?? 422.504(i)(2)(i) and 423.505(i)(2)(i) to make clear that CMS and its designees may "collect" records, in addition to their existing authority to "audit, evaluate, and inspect" information, from First-Tier, Downstream, and Other Related Entities (FDRs).

In accordance with these changes, the Medicare Advantage Addendum will be amended to read as follows:

Inspection and Audit. Contractor shall permit CMS, the Department of Health and Human Services (HHS), the Comptroller General, or their designees to audit, evaluate, collect, and inspect any books, contracts, computer, or other electronic systems, including medical records and documentation of the FDRs related to CMS's contract with the Medicare Advantage organization as it pertains to any Services provided under the Agreement. CMS, HHS, the Comptroller General, or their designees have the right to audit, evaluate, collect, and inspect any records directly from any FDRs. This right to audit, evaluate, collect, and inspect shall extend ten (10) years from the expiration or termination of the Agreement or completion of final audit, whichever is later, unless otherwise required by applicable Law.

Please note, this is for informational purposes only and does not require any action on your part at this time. Updates to the Medicare Advantage Addendum will take place upon contract renewal.