Tag Archives: CMS

The 2019 Application – Key Dates

Regan Pennypacker

As a follow up to my last article on the Notice of Intent to Apply, I give you an enhanced chart of 2019 application activities outlining things you should have been doing or should be in the middle of now. Thanks to the Centers for Medicare & Medicaid Services (CMS) for creating a base, published on Friday via memo – my colorful additions peppered throughout for your perusal. If past activities have not been done yet, it is time to get a move on, or you risk missing the deadline. Read more

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2018 Star Ratings Offer Valuable Insight into Competitive MA Industry

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) release yesterday of the 2018 Star Ratings offers valuable insights into the significantly competitive Medicare Advantage (MA) industry. Here are just a few early observations and some insight into why it’s important: Read more

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CMS Notice of Intent to Apply

Regan Pennypacker

The Centers for Medicare & Medicaid Services (CMS) Annual Call Letter calendar marks November 13, 2017, as the first due date for the Notice of Intent to Apply. It is expected the Center for Medicare will release a reminder memo this month outlining the details. In general, the agency requires a Notice of Intent to Apply to be submitted when an organization plans on submitting a request for any of the following: Read more

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10 CMS Program Audit Risks

Regan Pennypacker

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

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Backpedaling from Better Quality Measurement?

Melissa Smith

Few would argue Star Ratings is overdue for evolution. With almost 50 Star Ratings measures, many having been in the program for years, and Secretary Price and Administrator Verma both positioned to make their mark on Medicare, change is imminent. But change is also difficult, a fact acknowledged by the Centers for Medicare & Medicaid Services (CMS) when it reversed course in the 2018 Call Letter on several proposals included in the Advance Notice.

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Adjusting Star Ratings for Audits and Enforcement Actions

Regan Pennypacker

Within the Draft Calendar Year 2018 Call Letter, the Centers for Medicare & Medicaid Services (CMS) acknowledged the valuable comments received from the industry related to the use of audit findings and enforcement actions in the Star Ratings Program. As a result of those comments, CMS proposes a revision of the Beneficiary Access and Performance Problems (BAPP) measure.

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CMS Releases Widely Anticipated Proposed ACA regulation, the New Administration’s First Attempt at Market Stabilization

Olga Walther

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.

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