CMS requires applicants to demonstrate they have a sufficient network of contracted providers before an initial or service-area expansion application is approved. In addition, for CY 2024, CMS will adopt regulations explicitly permitting it to deny applications based on an applicant’s failure to meet network adequacy criteria. Plans
Read More →States begin Medicaid redetermination efforts on April 1, 2023 States will start Medicaid redetermination efforts on April 1, 2023. The Consolidated Appropriations Act, 2023 effectively terminated previous requirements that the redetermination period would begin at the end of the Public Health Emergency. If states meet the requirements, they’ll
Read More →In-home care plays an important role within the US healthcare system. When done correctly, an in-home assessment provides a comprehensive overview of a patient’s health status, which is vital to identify potential health risks and can help ensure optimal outcomes for members who are unable to receive
Read More →Plans should begin using the updated IDN no later than May 2, 2023 CMS updated an Office of Management and Budget-approved standardized Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN). Medicare health plans, including Dual-Eligible Special Needs plans (DSNPs),
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