On December 19, 2023, the HPMS memo 2024 Program Audit Updates was issued, containing several announcements effective January 1, 2024. Please note the following summary of the review results:
- Final rule CMS-4201-F included new coverage criteria requirements and use of utilization management (UM) requirements
- 2024 Audits
- Will utilize the newly approved version of the extended CMS-10717
- Routine audits will follow the standard process as in prior years
- Will target new UM requirements during ODAG and CPE review
- Focused audits are to be added for plans not scheduled for routine audits
- Limited to ODAG and CPE areas
- Sponsoring organizations:
- To hire an independent auditor when there are more than five conditions unrelated to the CPE review that require testing during the validation audit
- CMS will conduct validation of findings when audit results are below the threshold