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Tag Archives: CMS
Program audits and oversight activities must be designed with many factors to balance: accuracy, consistency, efficiency, and in an effort to be least disruptive to a plan sponsor. Correspondingly, a plan should be tailoring its response to these audits with those same factors in mind. My colleague Deb Devereaux and I outline ten common risk areas we observe in plans large and small. Read more
CMS Releases Widely Anticipated Proposed ACA regulation, the New Administration’s First Attempt at Market Stabilization
On February 15, 2017, the Centers for Medicare & Medicaid Services (CMS) released its widely anticipated proposed rule introducing new market health insurance market reforms. CMS is proposing changes for stricter Special Enrollment Period (SEP) verification, exceptions to guaranteed availability, updated network adequacy requirements, and a shorter Open Enrollment Period.
There are many industry voices adding their perspectives about the new administration and changes to come. However, the Compliance Officers I know do not have the luxury of stopping and truly considering the potential impact as they are managing the continuous pressures of their daily directives. Today I address a group of very industrious Compliance professionals not often addressed, and those are the staff responsible for Compliance Programs at first tier, downstream and related entities, or “FDRs.” Under Medicare regulations, plan sponsors may enter into contracts with FDRs to provide administrative or healthcare service functions on their behalf.
Most attention in health policy since the election has been on the looming repeal of the Affordable Care Act’s Exchanges and subsidies, but the far bigger story is what the incoming Trump Administration and the Republican Congressional majority are about to do to Medicaid, the Children’s Health Insurance Program (CHIP), and the Medicaid “mega-reg.” Literally 50 years of the social safety net could be shredded in the first weeks of 2017.
Imagine entering University and enrolling into Advanced French Language and Literature, a 300-level class, with no previous knowledge or study of the French language. As your professor welcomes you into class with bonjour, bienvenue, ça va, you have no idea how to reply. Now imagine sticking with that course for the full semester, trying to understand complex language and reading concepts without the foundation or basics. It would be quite an overwhelming few months for anyone.