About this table
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