CMS Model Materials—Significant Changes for CY23

Wow! The CMS model materials were released weeks earlier than previous years, and we’re thankful for that! There are significant changes for CY23: most notably the reduction in length, reorganization, and reduction of tables and language.

View the CY23 Models here: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/MarketngModelsStandardDocumentsandEducationalMaterial

CMS Model Materials Notable Changes

Annual Notice of Change (ANOC)—Notable Changes (applies to most plan types unless noted):

1. Reduction in length by roughly two pages
2. The table of contents (TOC) moved to proceed the Summary of Important Costs section
3. Combined the Provider and Pharmacy changes sections into one
4. Removed prior authorization changes from the Changes to Benefits and Costs for Medical Services section (except PDP)
5. Removed Opioid treatment program services content
6. Added content for Changes to your VBID Part D Benefit
7. Removed content related to the Coverage Gap and Catastrophic Coverage Gap stages

Evidence of Coverage (EOC)—Notable Changes (applies to most plan types unless noted):

1. Reduction in length by roughly 60 pages
2. Removed the TOC from individual chapters
3. Updated the term “booklet” to “document”
4. Removed duplicative language (ex. ‘phone numbers are printed on the back cover of this booklet’)
5. Large changes/restructure to Chapter 1 and Chapter 9 (MAPD) / Chapter 7 (MA only/PDP)
6. Combined Coverage Decisions and Appeals contact information charts in Chapter 2
7. Added language that, in an emergency, beneficiaries can get covered medical care (including pregnancy-related services) from any provider
8. Updated the description of urgently needed services to include examples in Chapter 3
9. Moved cost sharing information for oxygen from Chapter 3 to the Durable medical equipment (DME) and related supplies row in the Medical Benefits Chart in Chapter 4
10. Updated “Inpatient mental health care” to “Inpatient services in a psychiatric hospital” in the Medical Benefits Chart
11. Added language to telehealth services in the Medical Benefits Chart
12. Removed the ‘drug payment stage’ chart (MAPD/PDP)
13. Added content in the Your rights and responsibilities chapter regarding cultural sensitivity
14. Updated and added new language to the definitions for Chronic-Care Special Needs Plan (C-SNP) and Dual Eligible Special Needs Plans (D-SNP) in Chapter 12

Please note, this is just a summary of the notable changes to the ANOC and EOC. All plans should review the models closely for any and all changes or updates.

As a reminder, keep an eye out for additional corrections typically released in July!

We’re Here To Help—To find out how CODY^® can help your plan ensure readiness and maintain compliance, contact us today for a consultation.

About CODY: CODY® works with over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico. We help align internal operations with CMS guidelines to improve regulatory compliance, maximize performance, and streamline member/provider communications across the enterprise. CodySoft® and Membership Suite^™™, our proprietary suites of software, are designed specifically for health plans. www.codyconsulting.com