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 to submit Health Service Delivery filings through the Health Plan Management System Network Management Module for CY 2023 applications. The process for CMS to approve CY 2023 will continue through the summer.
Currently, health plans attest to a compliant network in February and submit their network in June. CMS now requires health plans submit networks with CY 2024 applications in mid-February. Per CY 2023 Final Rule published 5/9/22, CMS requires applicants to demonstrate they have a sufficient network of contracted providers to care for beneficiaries before they approve an application. 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.
1. Starting in 2023 (for CY 2024), network submissions and adequacy review returns to the previous MA application process with a few changes
- CMS can deny an application if the network is not adequate
- CMS will make the following allowances to help plans meet network adequacy in the shorter timeframe:
- 10% credit for initial CY 2024
- 10% telehealth credit
- 10% certificate of need credit as applicable with state laws
- 10% network adequacy credit for meeting requirements in initial phase
- It is anticipated (but not confirmed) that, based on network submitted, the network adequacy credit percentages will be in addition to the initial network-build credit, the telehealth credit and certificate of need credit.
2. Letters of intent (LOIs) may be used for initial submission
- MA organizations must notify CMS of intent to use LOIs to meet network adequacy requirements.
- MA organizations that use LOIs will automatically be included in triennial review (now on a “luck of the draw” basis).
3. MA organizations must be fully compliant by January 2, 2024
- LOIs will no longer be allowed to meet adequacy. Providers must be fully contracted/ credentialed.
- 10% credit no longer applies. Provider network must meet network adequacy requirements.
The aggressive timeline to complete and submit a provider network for CY 2024, with the risk of the application being denied in its entirety for a non-compliant network, is expected to strain health plan resources—especially plans that are finalizing CY 2023 applications and provider network submissions. If you need help tackling this aggressive timeline, contact us to learn how our network strategy and contracting experts can help.