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Reimbursement Issues

Reimbursement Issues

DOH Issues Managed Care Plan Notices

The SFY 2022-23 enrollment cap withhold returns and penalties will be "paused." In addition, as planned under the SFY 2023-24 budget, the increase in the medical loss ratio will take effect on April 1, 2024. For MAP plans, rates for certain OASAS services were increased.

September 18, 2023

Reimbursement Issues

CMS Releases Medicare Advantage Rates

Medicare Advantage and Part D Rate Announcement provides payment policies for CY 2024.

April 4, 2023

Reimbursement Issues

Deloitte and DOH Review FY 2024 MLTC Rate Development

Draft rates distributed to Partially Capitated MLTC and Medicaid Advantage Plus plans.

March 7, 2023

Reimbursement Issues

CMS Releases Medicare Advantage Advance Notice

CMS predicts proposals would result in an average plan revenue increase of 1.03 percent for CY 2024.

February 7, 2023

Reimbursement Issues

DOH Circulates 2023 MLTC Quality Incentive Methodology

DOH makes several changes to last year's measure set.

December 27, 2022

Reimbursement Issues

Wage Parity Attestations Due

MLTC plans as well as home care providers and FIs in areas covered by wage parity provisions must file compliance certifications by Oct. 1st.

September 27, 2022

Reimbursement Issues

Deloitte, DOH Outline Upcoming MLTC Rate Changes

Updated April 2022 rates for Partially Capitated and Medicaid Advantage Plus plans reflect 1 percent Medicaid increase, minimum wage.

August 23, 2022

Reimbursement Issues

DOH Encounter Reporting Reconciliation Requirements a Heavy Lift

The Department distributes 2021-22 Initial Findings Packets, works with plans to resolve discrepancies.

June 28, 2022

Reimbursement Issues

DOH Outlines Plans for Home Care Minimum Wage Increase and Premium Adjustments at Managed Care Finance Meeting

The meeting covered the expected timing and elements of premium revisions, including revisions to SFY 2022-23 rates based on the home care worker minimum wage increase, independent assessor implementation, and updated risk scores.

June 14, 2022

Reimbursement Issues

DOH Planning Risk Score Update to MLTC Rates

Plans encouraged to ensure that all members have a completed assessment for the 12-month period ending Sept. 30, 2022 as DOH prepares a mid-rate-year risk score update.

June 7, 2022
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