How to Prepare Your Medicare Advantage Initial or Service Area Expansion Application for CY 2024 & Beyond

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

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2024 Proposed Rule Changes: Medicare Advantage Agent/Broker Compliance Oversight | Medicare Advantage and ACA Provider Directories & Contracting | ACA HHS Risk Adjustment Data Validation

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

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Case Study | How ATTAC Helped a Large Multi-state Health Plan Win a Medicaid Bid by Expanding the Plan’s Provider Network

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

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Medicare Advantage Plans Completing Applications For New Markets or Service Areas Must Build-out Provider Networks at the Same Time

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

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Health Plan Weekly | Behavioral Health Network Issues Lead to $4.6M Fine for Molina

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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