Medicare-Medicaid Plans to Undergo Performance Measure Validation for 2023 Cycle 

Medicare-Medicaid plans (MMPs) report monitoring and performance measures consistent with the three-way contracts with states, the Medicare-Medicaid capitated financial alignment model core reporting requirements, and state-specific reporting requirements.   For the 2023 performance measure validation (PMV) cycle (covering data reported for the 2022 measurement year), CMS will select

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New Proposed Medicaid Regulations Aim to Enhance Access to Care & Health Equity | Submit Comments by July 3, 2023

New Proposed Medicaid Regulations Aim to Enhance Access to Care & Health Equity | Submit Comments by July 3, 2023

The proposed rule, Ensuring Access to Medicaid Services, includes changes to existing requirements and introduces new requirements. The proposed regulations advance CMS’s efforts to improve access to care, quality and health outcomes; the regulations are intended to promote health equity across fee-for-service (FFS) and managed care delivery

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Navigating the 2023 CMS Program Audit: Are You Ready?

CMS has initiated routine program audits by sending engagement letters to Medicare Advantage organizations, prescription drug plans and Medicare-Medicaid plans. Are You Audit-Ready? If your plan receives an engagement letter, are you prepared to respond within 15 business days, or do you feel nervous and hope you

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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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How to Prepare for Medicaid Redetermination

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

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