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Learn more about CMS Updates that may impact your PACE Plan.

Re-Determination of Part D Low-Income Subside Eligibility for 2017 –Dated 7/20/2016

Summary: CMS provides organizations with information and guidance on re-determination of LIS eligibility.

Action: Informational to PACE.  Refer to the memo for guidance and plan responsibilities.


Bid Pricing Tool (BPT) for Contract Year (CY) 2014 – XML File Submission Reminder –Dated 7/21/2016

Summary: The BPT process has changed.  Plans must submit two files in every bid submission.  Failure to include both files will result in an error in the bid data.

Action: Informational to PACE.  Refer to email for further details.


Cost Contract Transition Notice to Beneficiaries –Dated 7/21/2016

Summary: CMS released guidance on the submission of notice to beneficiaries on the cost contract transition provisions.

Action: Informational to PACE.  


CY 2017 Cumulative Opioid MED POS Edit Submission –Dated 7/21/2016

Summary: CMS expects Part D plans to implement either a soft and/or hard opioid edit based on morphine equivalent dose (MED) at the point of sale (POS).  Part D plans must complete the attached template and submit to HPMS between August 1, 2016 and September 1, 2016.  CMS also expects plans to have a written policy on the opioid edits at POS that CMS may request for review at any time.

Action: Informational to PACE.  Pharmastar will review and reach out to CMS for additional guidance.


Save the Date – MMP Provider and Pharmacy Directory Technical Assistance Call –Dated 7/25/2016

Summary: The Medicare-Medicaid Coordination Office will host a Provider and Pharmacy Directory technical assistance call for Medicare-Medicaid Plans (MMPs) on September 7, 2016 from 1-3pm ET to discuss the following:

  • Obtain feedback from MMPs about best practices and barriers to compliance
  • Provide information about lessons learned
  • Illustrate areas where there are gaps relative to contractual requirements
  • Discuss technical assistance and monitoring efforts

Action: Informational to PACE.


Release date for Part D National Average Monthly Bid Amount, Timeline for Rebate Reallocation Period, De Minimis, and other important 2017 information –Dated 7/26/2016

Summary: CMS plans to release the following information for plans:

  • Part D Beneficiary Premium
  • Part D National Average Monthly Bid Amount
  • Part D Regional Low-Income Premium Subsidy Amounts
  • Part D Income Monthly Adjustment Amounts
  • De Minimis Amount
  • Medicare Advantage EGWP regional payment rates
  • Medicare Advantage Regional Benchmarks

Action: Informational to PACE. Refer to memo for items that may be applicable to your plan.


Encounter Data Submission Timing Guidance- Reminder and Update –Dated 7/26/2016

Summary: CMS is reminding plans of the various submission guidelines for submitting encounter data.  

Action: Applicable to PACE.  Refer to memo for complete details.


Summer Limited Update Window for CY 2017 Formulary Submissions –Dated 7/27/2016

Summary: CMS reminds all plans of the importance of resolving any outstanding formulary concerns.  Plans whose formularies still have outstanding issues will be contacted by CMS to schedule a negotiation call. Only plans that have received prior CMS conditional formulary approval will be permitted to submit an update during the summer update window.  Plans must resolve all outstanding issues and receive conditional approval for their CY 2017 formulary no later than 5 PM ET on September 1, 2016 to be eligible to offer Part D benefits during CY 2017.

Action: Applicable to PACE plans that utilizes a formulary.  Refer to memo for additional information.


Medicare Advantage/Prescription Drug System (MARx) August 2016 Payment –INFORMATION 7/28/2016

Summary:CMS released information about the August payment and other payment related items that may require plan action:

  • 2016 Mid-Year Risk Adjustment Reconciliation

Action: Informational to PACE plans.  Refer to memo for items applicable to your plan.


Enhanced Medication Therapy Management (MTM) Model Stakeholders –Dated 7/28/2016

Summary: CMS announced the final specifications for the Enhanced Medication Therapy Management (MTM) model encounter data elements.  

Action: Informational to PACE as PACE plans are waived of the requirements of the MTM program.


Availability of CAHPS Data –Dated 7/28/2016

Summary: CAHPS data will be available to all contracts by late August.  

Action: Informational to PACE as PACE is waived of the CAHPS requirement.

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Please note that this information is provided to you in summary form for general informational purposes only and does not constitute legal or regulatory compliance advice.  It is your responsibility to consult with your Compliance Officer and/or legal counsel to determine applicability of any regulation or standards referenced herein to your organization and/or processes.


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