Reasonableness — The Last Chance

After four tries, some Marketplace health plan applicants have still failed to meet CMS reasonableness standards for 2015.  Some of these applicants complained that they did everything they were told to do but were again rejected. Others are still asking for definition and written standards.  Unfortunately, most understand that nothing in writing exists beyond the regulation.

In response, CMS encouraged them to call and discuss their issues next week when the subject matter expert is available.  Their appeal is limited to a phone conversation with this lone CMS interpreter of reasonableness.  These applicants need to have definitive data about available providers, population and time and distance to convince this reviewer.  Demonstrating the use of a deliberative process may be the lesson for 2016 applicants but for 2015, time has run out.

Resources

We’ve assisted scores of organizations through every step of the application process, from gathering the right data, completing the application, submitting, and responding to follow-up questions. Learn more about how GHG can help you tackle the application process >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>