What Does CMS’ Final Rule for 2023 Mean for You?

In late April 2022, CMS announced the changes to the Medicare Advantage (MA) program for 2023, and the implications for health care organizations submitting provider networks for approval for plan year 2024 are major, to say the least. If, like most, your organization finds itself scrambling to complete your network build before the June submission deadline, you’re not going to be thrilled. Timelines got a lot tighter.

Gone are the days when you could submit renewal or expansion applications in February knowing you had more than three months to contract providers for formal submissions of bids in early June.

To ensure that Medicare beneficiaries have sufficient access to care, “CMS is requiring that MA applicants demonstrate they have a sufficient network of contracted providers to care for beneficiaries before CMS will approve an application for a new or expanded MA contract.” Gone are the days when you could submit renewal or expansion applications in February knowing you had more than three months to contract providers for formal submissions of bids in early June. Starting with CY 2024, you have to apply and submit provider networks at the same time–in February. The silver lining, albeit a small one, is that CMS will accept letters of intent (LOIs) from providers in lieu of signed contracts, giving you extra time (until the end of 2023) to get provider and facility contracts signed.

If you’re just finishing your CY 2023 MA networks (as is probably the case), you’ve got just over eight months to get your CY 2024 networks built.

As in eight months to:

  • Conduct market assessments
  • Make your go/no go decisions

  • Recruit providers and facilities

  • Get LOIs signed

You might think that means you’ve got to cancel your vacation plans, but there are some options you may not have considered

 

Option #1:

Scale Up Your Capacity with andros

andros scales up your team’s capacity to build compliant provider networks in new markets—while reducing your administrative costs—using our optimized process and powerful technology. Drawing on the 7.4 million provider profiles in the a* Platform, the healthcare industry’s largest provider database, andros can help you quickly assess markets for initial build and expansion networks, then leverage our fastest-path-to-adequacy network modeling approach to allow you to make quick decisions on whether you can build your network to adequacy. That way you retain strategic flexibility to either build or pivot, reducing the risk of wasted time and resources.

Option #2:

Consider Subscription-Model MA Network Management

With its innovative network development and management subscription model, andros offers health plans the flexibility to use our capabilities where you most need them. Use your internal team to focus on your CY 2023 network and leverage andros to recruit providers and get signed LOIs for your CY 2024 network–or vice versa. With the androsFlex subscription, you get the benefits of andros throughout your MA network’s entire lifecycle, from recruiting to contracting, credentialing, and monitoring, so you have the flexibility to deploy resources where they can make the most impact at a predictable cost.

Leverage andros to recruit providers and get signed LOIs for your CY 2024

Option #3:

Leverage External Contracting and Credentialing Resources

The one area where this rule change benefits health plans building MA networks is the extended window of time for contracting. If you have the capacity to assess

markets and build the MA networks you’re targeting for CY 2024 in-house, you’re actually in great shape–because most of the competition will be scrambling. One way to make sure you maintain and build on that advantage is by leveraging andros capabilities to contract and credential networks. Make your submission in February 2023 with signed LOIs, knowing that andros can use its workflow- optimized recruiting process to deliver signed contracts for credentialed providers (and facilities) in time for CY 2024.

With experience building and credentialing networks in all 50 states and in 67% of counties containing 92% of the population of the US, andros has the technology, experience, and scale to ensure you handle the rapid transition to CY 2024 MA builds smoothly and successfully.

More To Explore

From Direct Contracting Model to ACO REACH: Navigating the Continued Evolution of Value-Based Care in Traditional Medicare

With a speedy makeover for the Global and Professional Direct Contracting Model, CMS is making sure to incorporate lessons learned from previous value-based care programs. The revamped ACO REACH initiative aims to make it easier and more rewarding to embrace value-driven principles in traditional Medicare. Introduction Ever since the Affordable Care Act (ACA) became the

Delegated Credentialing: Easing the pain of credentialing your providers

Delegated Credentialing: Easing the pain of credentialing your providers Credentialing in house can be painful for health plans and other types of payors, adding the time and administrative stress of continually tracking and updating new providers, locations, and information. It can be burdensome for provider organizations too, submitting new documents with each provider, location and

Scroll to Top