Quest Analytics Legislative Brief
CHANGES TO THE MEDICARE ADVANTAGE APPLICATION NETWORK ADEQUACY RULES
Updated Brief as of January 15, 2023
CMS CY 2023 Medicare Advantage and Part D Final Rule
MEDICARE ADVANTAGE PLANS MUST DEMONSTRATE A COMPLIANT NETWORK AT APPLICATION
Medicare Advantage Organizations (MAOs) have recently been hit with a big change in what’s required of them during their application process. Medicare Advantage Applicants must demonstrate compliance with network adequacy standards and submit HSD tables as part of the Medicare Advantage Application process. Don’t worry — we’ve got you covered! Here’s your insider guide to navigating these changes and staying on track with expansion plans.
Updated with the latest information regarding the operational instructions for using the Application Credit and Letters of Intent.
Reminder! Application Deadline: Applications must be submitted and received no later than February 15, 2023, at 8:00 p.m. EST
Now is your chance to get the key details you need to apply! Download the Legislative Brief today and make sure your
MEDICARE ADVANTAGE APPLICATION CHANGES
- Beginning with the Contract Year 2024, MAOs must demonstrate full network adequacy compliance at the time of application, February 15, 2023.
- 10% Application credit will be applied during the application review. Once the contract year starts, plans must meet full compliance for the service area in addition to any other applicable credit (e.g. Telehealth and CON).
- Letters of Intent (LOI) can be used in lieu of signed provider contracts during application review. If LOI is used during the application process, the plan will have to participate in Triennial Review during the first contract year.
CMS Resource Hub
Looking for more tips to help you stay review-ready and compliant-confident with CMS? We’ve got them! Explore our CMS Resource Hub to find our growing collection of guides, videos and tools to help you achieve your compliance and service area expansion goals.
