Advising Health Plans on CMS Plan Requirements & Applications

The Situation

Mintz has represented multiple health plans seeking to contract with the Centers for Medicare & Medicaid Services (“CMS”) to offer Medicare Advantage (“MA”) Plans, Part D Plans, or both.  Some clients have engaged us to assist them through the application process, and others have engaged us to respond to notices of deficiencies and application denials.

The Approach

Mintz has an in-depth understanding of the MA and Part D plan requirements and application process and the information that is important to communicate to CMS. We work closely with our clients to learn their business strengths, highlight information that demonstrates to CMS that the client is ready and able to offer an MA or Part D plan, or both, and ensure the application is complete.

For clients that have engaged us to address deficiencies or denials, we first work quickly to learn what application issues resulted in CMS’s negative review. In some instances, the identified issue is discrete and easy to address. At other times, the CMS-identified potential deficiency has been more significant. In those circumstances, we quickly learn our client's business and carefully review the denied application to determine, based on our knowledge of MA and Part D regulations and guidance, what could have been communicated differently to demonstrate to CMS that the client can satisfy the requirements to offer MA and Part D plans. We use this information to write well-reasoned briefs in response to CMS’s initial decisions. During the entire process of appeals, we strive to have open communication with CMS and this has led to positive outcomes for our clients.

The Outcome

We have been able to secure CMS approvals for clients through the application process, successfully address notices of deficiencies, and work with CMS to overturn application denials.