Washington, DC (PRWEB) November 06, 2015
Two strong trends in Medicare Advantage (MA) — the business incentive to boost star quality ratings and the Centers for Medicare & Medicaid Services’ (CMS) new network-adequacy initiatives — pull MA plans in opposite directions and on a possible collision course with regulatory problems. Responding to concerns from advocates and providers, CMS is implementing new initiatives to ensure that MA sponsors don’t offer robust networks initially and then narrow those networks shortly afterward. Atlantic Information Services, Inc.’s (AIS) upcoming Nov. 17 webinar, “Enhanced CMS Oversight of Network Adequacy: Strategies for Medicare Advantage Plans,” will explain the steps CMS is taking and offer detailed strategies that MA plans and partners can use to achieve strong business and regulatory outcomes.
Michael Adelberg, senior director at FaegreBD Consulting, and Deborah Schreiber, network compliance officer/Medicare deputy compliance officer for the UnitedHealthcare Medicare & Retirement unit of UnitedHealth Group, will answer these and related questions:
- What recent developments in MA networks account for the increased CMS scrutiny?
- Which new tools has CMS developed to deal with network adequacy in MA? What gaps do they address in the previous enforcement efforts?
- What new steps has CMS taken regarding MA provider-directory requirements? What steps should plans take in response?
- What lessons can be learned from CMS’s pilot MA network-adequacy audits? Where is this audit program going next?
- How is CMS expected to deploy its new guidance on Special Enrollment Periods (SEPs) for significant midyear network disruptions?
- How can MA sponsors avoid these SEPs while still changing network composition when needed?
- What additional actions is CMS likely to take in the future — including “machine readable” directory requirements and “secret shopping” — to ensure MA network adequacy?
- How can MA plans incorporate needed innovations, such as tiered networks and telemedicine, without risking noncompliance with CMS’s network-adequacy scrutiny?
The 90-minute program will also include a 30-minute Q&A session.
Visit https://aishealth.com/marketplace/c5a24_111715 for more details and registration information.
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.