Navigating The CMS Requirements For Medicare Advantage Plans In The Wake Of COVID-19

By Jack Meere, Senior Director of Business Development, TransPerfect Healthcare Practice Group

One of the great aspects of getting to work with Medicare Advantage Plans in all 50 States and U.S. territories is hearing about the unique challenges they face based not only on their individual membership size but on how they interpret the various regulations outlined by the Centers for Medicare & Medicaid Services (CMS).  What has been particularly interesting during the wake of COVID-19 is how plans across the country have had to not only comply and interpret the changing measures outlined by CMS but juggle that with the guidance governed by their individual States.  This combined with the fact plans are servicing the most at risk demographic has caused a significant amount of unknowns in the managed care industry as leadership teams in the Medicare Advantage (MA) space try to navigate for lack of a better term the “New Normal”. 

After having had several conversations with our client leadership teams in the MA space across the country with membership sizes ranging from 2,000 up to 49 million each plan has offered their unique perspective on the challenges they have faced.  Outlined below are a few of those challenge areas along with steps they have taken to mediate risk both in remaining HIPAA and PHI compliant while keeping their members and business healthy in the wake of COVID-19.