The ultimate rule implementing “Contract Yr 2023 Coverage and Technical Adjustments to the Medicare Benefit and Medicare Prescription Drug Profit Packages” is now obtainable for evaluate, and set for publication within the Might 9, 2022 Federal Register. The ultimate rule adopts the proposed change that requires preliminary and repair space growth candidates to submit their proposed contracted networks through the utility course of. The ultimate rule delays this variation from contract 12 months 2023 to contract 12 months 2024.
In making this variation, CMS is mainly reverting to its course of previous to 2019, when it started permitting plans to attest to community adequacy for brand spanking new contract or service space growth functions, and relied on its triennial community evaluate course of to judge compliance with community adequacy requirements for brand spanking new and expanded contracts.
CMS expressed concern based mostly on three years of expertise that the attestation-only course of may have an effect on the integrity of the bidding course of. It particularly famous that quite a few plans have requested to cut back the service space recognized of their bid proposal as soon as they realized that they didn’t have a adequate community for a number of counties included within the service space. The quantity recognized as in search of such adjustments is small: since 2019, 5 organizations requested to make adjustments to the service space of a complete of 10 plans after bid submission deadlines. Nevertheless, in CMS’ view, when a plan has to revise its bid to take away a county, it’s seemingly that the preliminary bid submission was not full, well timed, or correct.
CMS additionally famous that its post-application community adequacy critiques confirmed a sample of organizations persevering with to have insufficient networks even after their contract turned operational. CMS discovered a complete of 19 plans that fell into this class.
The unique situation that prompted the change in 2019 has not gone away, which is the potential problem of candidates securing a full supplier community virtually a 12 months prematurely of the contract turning into operational. The applying is usually submitted in February – round 10 months previous to the contract 12 months that begins on January 1. CMS acquired many feedback concerning the problem of acquiring remaining contracts in time for the appliance course of, particularly in underserved areas or these with comparatively few suppliers.
CMS acknowledged the validity of plan feedback, and didn’t totally clarify why it determined to vary the appliance course of for all plans, slightly than utilizing its authority to take measures towards the small variety of plans which have demonstrated an issue with community adequacy compliance – corresponding to disapproving a request for a brand new contract or service space growth for a plan that seeks to vary its service space after bid submission, or suspending enrollment till an operational plan comes into compliance with community adequacy requirements. As an alternative, CMS will present two forms of pretty restricted flexibility for organizations to mitigate the impression of the change:
- CMS will enable a 10-percentage level credit score in direction of the proportion of beneficiaries residing inside revealed time and distance requirements for the contracted community within the pending service space, on the time of utility and throughout the appliance evaluate.
- CMS will enable plans to make use of letters of intent (LOIs) in lieu of signed supplier contracts, on the time of utility and throughout the appliance evaluate. The LOI should be signed by each the MA group and the supplier. Candidates should notify CMS of their use of LOIs to satisfy community requirements.
At first of the contract 12 months (that’s, January 1), this flexibility would now not apply, and plans would want to satisfy community adequacy requirements for your complete service space with remaining, signed supplier and facility contracts.
