Member

Switch to:

CMS requirement on Medicare “Preclusion List” effective Jan. 1

02/01/2019

As you may know, new regulations from the Centers for Medicare & Medicaid Services now prohibits Medicare Advantage plans, like ConnectiCare, from paying for health care items, services and prescriptions by individuals and entities listed in CMS’ Medicare “Preclusion List.” This went into effect Jan. 1, 2019.

The “Preclusion List” will be compiled by CMS and will include providers and suppliers who fall within any of the following categories:

  • “are currently revoked from Medicare, are under an active reenrollment bar, and CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program;" or
  • “have engaged in behavior for which CMS could have revoked the prescriber, individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program. Such conduct includes, but are not limited to, felony convictions and Office of Inspector General (OIG) exclusions.” 

ConnectiCare Medicare Advantage members affected by this new regulation will receive a letter from us starting this month. We will also send copies of those member letters to the affected providers.

To learn more about the “Preclusion List,” visit the CMS website