CMS’s Plan Benefit Package (PBP) Software—Technical Redesign Coming to HPMS
CMS is modernizing its Plan Benefit Package (PBP) bid submission module for Contract Year (CY) 2024 Going live on April 7, 2023—the new web-based Plan Benefit Package (PBP) Software Technical Redesign will live within the Health Plan Management System (HPMS) and include updates to the user interface and data entry workflow. In previous years, users…
Read MoreCMS CY 2024 Advanced Notice — The Inflation Reduction Act Requirements on Member Communications
Comments are due by March 3, 2023. The final notice will be released by April 3, 2023. The Inflation Reduction Act (IRA) of 2022 provides many provisions to reduce prescription drug costs for Medicare beneficiaries and Medicare Advantage (MA) members. The CMS CY 2024 Advance Notice included updates related to the IRA that should be…
Read MoreHow to Promote a Strong Compliance Culture—That’s Effective!
An organization’s commitment to compliance, or its compliance culture, is an important component of its overall organizational culture. Organizational culture is defined in The Cambridge Dictionary as the types of attitudes and agreed ways of working shared by the employees of a company or organization. A strong compliance culture is an organization-wide commitment to adhere…
Read MoreCMS Proposed Rule — CY 2024 Policy and Technical Changes
CMS Proposed Rule- On December 14, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the Proposed Rule for Calendar Year 2024 Policy and Technical Changes that includes revisions to regulations governing Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the…
Read MoreModel of Care (MOC) Development — What You Need to Know
Model of Care (MOC) approvals expiring December 31, 2022, must submit a new MOC by February 2023. CODY® can help you gain a 2- or 3-year approval on your Dual-Eligible SNPs (D-SNP) or Institutional SNPs (I-SNP) Model of Care (MOC). For Chronic SNPs (C-SNP), we can provide a review of requirements prior to the annual…
Read MoreOpen Enrollment Period (OEP)—How to Retain Members
You have worked hard to gain and retain members—don’t let the Medicare Advantage Open Enrollment Period (MA OEP) be a time to lose them! The MA OEP runs from January 1 – March 31. During the MA OEP, Medicare Advantage plan members may switch to another MA plan or disenroll from their MA plan, return…
Read MoreCall Center Monitoring — Star Rating Measure Tips for Success
Call Center Monitoring is one of your first Star Rating measures of the new contract year. Starting in February 2023, CMS will measure interpreter and TTY availability as a metric for the CY24 Star Ratings. Monitoring calls will be placed on your prospective enrollee call center phone lines. These calls will measure interpreter availability, TTY…
Read MoreCMS Audits – Be Prepared to Avoid These Common Findings
As the 2022 Program Audit Cycle winds up with the last of the routine audit engagement letters issued in July, we are starting to see the audit results. This year saw new audit protocols, and some plans struggled with the new universe layouts. In addition, CMS added a new observation classification – ORCAs (Observation Requiring…
Read MoreCMS End-of-Year (EOY) Low-Income-Subsidy (LIS) Activities—Is Your Health Plan Up to Date?
Hopefully, you are off to a successful AEP! To keep the momentum going, here’s some valuable information and best practices regarding EOY activities, including the Low-Income Subsidy (LIS)/Reassignment process. Is your staff well-versed in these activities? Are your systems ready to accept CMS’ year-end files? If not, read on to learn more! As referenced in…
Read MoreCY 2023 CMS Readiness Checklist – Why is this Exercise Important?
Every October, the Centers for Medicare & Medicaid Services (CMS) distributes a Readiness Checklist to Medicare Advantage and Prescription Drug Plan (MAPD) Sponsors as a reminder to prepare for the upcoming plan year. Although CMS no longer requires Sponsors to submit assessment attestations, CMS still expects Sponsors to review the comprehensive checklist and self-assess their…
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