CMS recently released updated operational guidance for Contract Year (CY) 2027 Medicare Advantage (MA) applications. This guidance introduces pivotal shifts in how organizations manage network adequacy and exception requests, meaning the “old way” of managing deficiencies is no longer sufficient for those preparing for the February submission.
Read More →
The Veteran Affairs Community Care Network (VA CCN) is a program that allows veterans to get healthcare services in their communities instead of having to go to a VA facility. It connects veterans with local healthcare providers who have agreements with the VA. The goal is
Read More →
CMS has implemented significant regulatory changes to network adequacy standards that require Medicare Advantage (MA) plans to quickly adapt to ensure compliance. Read on for an overview of the necessary steps plans must take to meet these new requirements. Convert Letters of Intent. Health plans that submitted
Read More →– by Jocelyn Bayliss, Program Lead, Provider Network Management & Tina Gallagher, Market Manager, Provider Network Management In April 2023, CMS issued a final rule that added two new specialty types, clinical psychology and clinical social work, to network adequacy standards. Addition of Specialty Types and Amendments
Read More →Reprinted with AIS Health permission from the Oct. 5 issue of Radar on Medicare Advantage As the 2024 Annual Election Period approaches, Medicare Advantage insurers that began marketing on Oct. 1 have been touting service area expansions and/or the robust provider networks attached to their plans. But
Read More →Per the CY 2023 Final Rule published on May 9, 2022, CMS requires applicants to demonstrate a sufficient network of contracted providers to care for beneficiaries before approving their application. Additionally, for CY 2024, CMS adopted regulations explicitly stating that applications may be denied if network adequacy
Read More →
