While the hope is for these rules to serve as collectively beneficial, some changes just might make things more difficult. We're in this together, right?
Thanks for reading ROC - Rehab Owners Community! Subscribe for free to receive new posts and support my work.
Whether you desire to join our live meetings (please do), or you’re in the market for an aesthetically pleasing refresher on the latest industry updates, we’ve got you covered.
As of January 1, 2023, Cigna IFPs (non-sponsored Marketplace and Individual Family Plans) have new restrictions.
Network: IFPs are part of the CIGNA CONNECT network, which have regional coverage limitations. Your Cigna contract will show whether you are eligible to accept IFP patients.
QHP plans to meet specific requirements under the Affordable Care Act, as well they have been certified by the Centers for Medicare and Medicaid Services (CMS). QHP plans often have access to unique networks with fewer participating providers than our traditional networks.
Aetna QHPs typically begin with number ‘101’ (no prefix or preceding “W”) *Availity will show the policy as a QHP/IFP
Example:
Aetna QHP/IFPs have both GEOGRAPHIC and NETWORK restrictions.
GEOGRAPHICALLY, they are limited to the member’s service area, which you can find by looking up their county (using the address from Availity) and checking against the maps below.
The NETWORK is restricted to facilities whose contract has been amended to include QHPs. Facilities that are INN with Aetna are not necessarily INN with QHPs. For now, safest path is a call to Aetna, to confirm coverage.
For our Arizona, California, and Oregon providers – we have positive MHN news to share -
As you know, previously, MHN has denied detox to anyone treatment with a history of seizures, pushing them into the hospital system. However, as of January 1, 2023, MHN has reversed that mandate.
For those admitted with a history of seizures, MHN will allow detoxification at your facility ONLY IF:
· The treatment team of providers are willing to attest to offering a safe detox environment.
AND
· The Attending Provider is willing to assume responsibility for the client’s care.
We end every Masterminds discussion by sharing our ‘Needs & Leads,’ where we offer an open dialogue to approaching obstacles (like hiring needs), or, Leadsand references (like referrals, introductions).
Just finished reading "Traction." Excellent recommendation. I am looking forward to implementing EOS in my program.