Planning for an upcoming benefit year starts more than a year prior with an annual CMS application cycle for new contracts and service area expansion. Below is a brief timeline of key functions, using the past 18 months as an example.
2021: Quarters 3 and 4:
- The business development and legal teams begin the HMO application process for any new states to be offered in the 2023 benefit year.
- Executive directors participate in discussions with partners about benefit design, marketing, sales, clinical models, and other key functions, to identify what is working well and what may need enhancement or discontinuation.
- Executive directors and network development teams start planning for 2023 service area expansion and identify key counties to target for provider contracting.
- Implementation and Operation teams begin onsite training of partner home staff and key affiliated providers, such as educating them about the benefits of the plan, the impact to clinical and administrative functions, information about the annual enrollment period and our unique model of care.
- CMS finalizes 2022 contracts with each plan in September. Each plan is required to share the annual notice of change with all current members, documenting any premiums, benefits, cost share or administrative changes to expect in 2022.
- The annual enrollment period starts on October 1. Enrollment counselors begin meeting with qualifying beneficiaries and enroll them in the 2022 benefit year.
- Late Q4, we are required to submit a notice of intent to apply to CMS for any new contracts as well as any 2023 service area expansions.
2022: Quarters 1 and 2
- The business development, legal and operations teams prepare and submit the CMS application in mid-February. Throughout the following months, CMS identifies any deficiencies with the application, allowing the plan to resolve to meet all requirements.
- Executive directors meet with the Medicare product team to review any requested benefit changes for the 2023 benefit year.
- In early June, the plan and contracted actuaries create and submit annual bids for each 2023 benefit package. During the desk review period, CMS delegated actuaries and the plan work together to address any questions or open items that need to be addressed to finalize bids.
2022: Quarter 3 and 4
- In August, the 2023 benefit year bids are finalized by CMS. The plan begins development of all 2023 marketing and enrollment materials to prepare for the AEP season beginning in October 2022.
- The cycle starts over.