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 →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →2024 Proposed Rule Changes: Impacts to Medicare Advantage & ACA Provider Directories and Contracting
CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →A multi-state Medicaid plan faced a competitive bid for contract renewal. The state is moving to mandatory managed Medicaid for its standard Medicaid population as well as dual-eligible and long-term services and supports’ enrollees who need home- and community-based services. It was a substantial rebid with a
Read More →CMS in a recent bulletin unveiled a “suite of new resources” aimed at guiding states and CMS in their oversight of Medicaid and CHIP programs, including managed care programs. Two items of particular interest to managed care organizations in a July 6 Center for Medicaid and CHIP Services
Read More →The Centers for Medicare & Medicaid Services (CMS) requires that all health plans have written standards for access to care timeliness and member services. Your health plan is required to: Most states have a standard set requirement for primary and specialty care access and availability. Is your
Read More →Medicare Advantage (MA) health plans that submitted CY 2023 applications are addressing network deficiencies AT THE SAME TIME they’re planning initial applications for new markets or service area expansion for CY 2024. Provider network submissions for CY 2024 will be due to CMS in February 2023. Plans have started
Read More →Shifts in the managed care landscape have reinforced the need for health plans to engage providers to drive accuracy of risk scores at point of care. As health plans and providers adopt value-based reimbursement and risk-sharing models, ensuring accuracy of risk scores becomes an increasingly integral part
Read More →Meeting Medicaid network adequacy requirements for behavioral health providers continues to be a challenge for health insurers, as shown by a recent $4.6 million settlement between Molina Healthcare, Inc., its former behavioral health subsidiary, Pathways of Massachusetts, and the Department of Justice. In the case, Molina and Pathways
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