Consulting Services
Market Assessment: We can help organizations identify potential new markets and/or service area expansions. Retium Health will provide a high-level market assessment including key players in the market, market share, overall MA penetration rates, critical facilities. This will allow organizations to make an initial determination of interest and feasibility to enter these markets
Assess Current Network Coverage: The goal is to determine if current networks and agreements with providers will allow an organization to meet CMS network adequacy requirements in the new markets. By establishing early on in the process the situation vis-a-vis MA network standards, organizations can focus on identifying key providers required to be compliant
Identify Counties with Deficiencies: During this stage of the process, we identify deficiencies and identify potential alternative providers. Retium Health will also validate the CMS supply file and determine incorrect providers in order to select alternative providers in those deficient areas. This step is critical so plans can determine if they want to “drop” from their bid and county where you are not able to meet standards and avoid affecting your entire contract.
Support Consultation Process: It is critical to work with CMS during the process in order to be better prepared when it is time for the formal network submission (HSD tables). During these interactions, plans can explain any challenges, how they are addressing deficiencies, concerns with the ability to meet criteria in a specific county due to errors in the CMS supply file. Retium Health will support these conversations with CMS which should help streamline the network review process.
Develop Exception Requests as Needed: Plans have had challenges with the ER process, from submitting inappropriate rationales to providing ERs when they are not needed, therefore creating additional work for your group as well as CMS. Retium Health will help organizations with developing justifications for any exception that is submitted. This will include the reason for the ER as well as the identification of an alternative provider.
Key Changes in CMS’s proposed rule
CMS’s new MA proposed rule will require that plans demonstrate compliance with network adequacy standards as part of the MA application process for new markets and service area expansions. Organizations will need to simultaneously work on their CY2023 network submissions and their CY2024 new market/SAE decisions and understand potential network challenges early on in the process.