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

Social Security Number Removal Initiative (SSNRI) Selected Updates for Medicare Advantage and Part D Plans –Dated 11/18/2016

Summary: The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that CMS remove Social Security Numbers from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace HICN on new Medicare cards which will be issued to beneficiaries no earlier than April 2018. The transition period in which CMS will accept either the HICN or MBI when submitting data to the agency will begin no earlier than April 2018 and run through December 2019.

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

 

December Actuarial User Group Call and Release of CY 2018 BPT Updates –Dated 11/18/2016

Summary: CMS Office of the Actuary will host an actuarial user group call on December 1, 2016 at 11:00AM ET to review the CY 2017 bidding process, discuss potential changes for CY 2018 Bid Pricing Tools, and to respond to questions from industry actuaries. A link to the agenda as well as participant dial-in information is referenced in the memo.

Action: Informational to PACE.

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CORRECTED LINK: Notice of the 30-day comment period for the Information Collection Request (ICR) for the Part C and Part D Data Validation for 2017-2018 –Dated 11/22/2016

Summary: CMS announced the opportunity for plans to comment on the proposed ICR for the Medicare Part C and Part D Data Validation for Reporting Requirements data for the 2017 and 2018 collection periods.  Comments can be submitted by December 5, 2016. A corrected link is provided.

Action: Informational to PACE.

 

Release of the 2014 Part C and Part D Annual Reports, Public Use File (PUF) Technical Specifications, PUF files for the Part C and D Reporting Requirements –Dated 11/22/2016

Summary: CMS has released the: 2014 Part C and Part D Annual Reports, PUF Technical Specifications of CY 2014 Part C and D Reporting Requirements Data, and 2014 Par C and D PUF. A link to these files can be found within the memo.

Action: Informational to PACE.

 

Medicare Diabetes Prevention Program Expanded Model –Dated 11/23/2016

Summary: This addresses implementation of the Medicare Diabetes Prevention Program (MDPP) expanded model as it pertains to MAO’s Section 1876 and 1833 Cost Plans, PACE organizations, and Medicare-Medicaid Plans. Effective January 1, 2018, MDPP services will be covered for eligible Medicare beneficiaries under all Medicare health plans (covered at zero cost-sharing). Specific information regarding the MDPP expansion and eligibility can be found within the memo. 

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

 

Coverage Gap Discount Program: December Participating Labeler Code Update –Dated 11/25/2016

Summary: CMS will be updating the list of participating manufacturer labeler codes for the Coverage Gap Discount Program by December 1, 2016. A link to the update is listed in the email.

Action: Although the Coverage Gap Discount Program does not apply to PACE, the participating labeler codes are applicable because only brand name prescriptions with NDCs from these codes are accepted for Part D payment.  Pharmastar has made the necessary software adjustments to accommodate for the updated codes.

 

Upcoming Training for PACE Organizations on Part D Coordination of Benefits –Dated 11/25/2016

Summary: CMS released information on the upcoming PACE training on Part D Coordination of Benefits.  The training session will be held on December 1, 2016 at 3pm EST

Action: Applicable to PACE.  For individuals who are interested in attending the session, refer to the email for additional details.

 

Medicare Advantage/Prescription Drug System (MARx) December 2016 Payment – INFORMATION –Dated 11/25/2016

Summary: CMS released information on the December payment which is scheduled for December 1, 2016 and may require plan action:

  • Coverage Gap Discount (CGD) Invoice Offsets
  • MARx Operating Calendar for 2017
  • 2017 User Fees

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

 

SNP and MMP Off-Cycle MOC Revision Submissions Training –Dated 11/25/2016

Summary: CMS corrected the phone number to the Off-cycle Submission of Model of Care training which will be held on November 30, 2016.  

Action: Informational to PACE.  Refer to email for complete training session information.

 

Correction- August 8, 2016 Guidance Re: Nondiscrimination Communication Requirements and Grievance Procedures –Dated 11/28/2016

Summary: CMS corrected the telephone number provided in a link which was previously included in an HPMS memo entitled, Guidance regarding implementation of the procedural requirements under the regulation implementing Section 1557 of the Affordable Care Act of 2010 – Nondiscrimination and Accessibility Requirements and Grievance Procedures. 

Action: Informational to PACE.  Refer to the email for complete details.

 

Personnel Changes in the Center for Medicare –Dated 11/28/2016

Summary: This email is to announce the new roles listed below at CMS:

  • Arrah Tabe-Bedward- Deputy Director of the Center for Medicare and Medicaid Innovation (CMMI)
  • Jerry Mulcahy- Director of MEAG
  • Mike Crochunis- Deputy Group Director of the MEAG
  • Vikki Ahern- Director of MOEG, and has become a member of the Senior Executive Service (SES)
  • Judy Geisler- Deputy Group Director of the MOEG

Action: Informational to PACE.

 

Contract Year 2016 Quality Improvement Project – Annual Update Training Information –Dated 11/28/2016

Summary: CMS provided MAOs and MMPs with information on the upcoming training for the CY 2016 QIP Annual Update submissions. The window for submissions will be from 12:00am ET on January 9, 2017, through 8:00pm ET on January 13, 2017. CMS will conduct the CY 2016 QIP Annual Update Training on December 13, 2016. Information for those unable to attend is provided within the memo.

Action: Informational to PACE.  Refer to the memo for complete details on the training information.

 

Industry-wide Appeals Timeliness Monitoring –Dated 11/28/2016

Summary: CMS provided an overview of a large scale monitoring project that will be implemented around Part C organization determinations and reconsiderations and Part D coverage determinations and redeterminations. The goals of this project are to provide greater information to evaluate the integrity and completeness of the IRE data and to improve the overall monitoring of compliance with ODAG and CDAG.  Each contract will be contacted by one of the listed contractors with additional information and instructions on the test period, how to submit the data and with submission deadlines.

Action: Informational to PACE as PACE is excluded from this data submission.

 

RESEND – Medicare Advantage/Prescription Drug System (MARx) December 2016 Payment – INFORMATION –Dated 11/25/2016

Summary: CMS attached the calendar referenced in the memo and information about the December payment and other payment related items that may require plan action which is scheduled for receipt on December 1, 2016.

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

 

Early Preview – CY2018 Medicare Advantage Ratebook Growth Rates –Dated 11/29/2016

Summary: CMS released the CY 2017 premium determination estimates of the United States Per Capita Cost for beneficiaries entitled to Part A and/or enrolled in Part B.  The estimates are preliminary and could change.

Action: Informational to PACE.

 

Long-Term Institutionalized Resident Report –Dated 12/1/2016

Summary: The fourth 2016 LTI Resident Report will be distributed to plans on December 1, 2016.  Organizations will only receive a LTI report if they have LTI enrollees.  The layout of the file is provided.

Action: Informational to PACE plans who receives the LTI Resident Reports.

 

November 28, 2016, Industry-wide Appeals Timeliness Monitoring Memo –Dated 12/2/2016

Summary: CMS clarified the Industry-wide Appeals Timeliness Monitoring effort that was released on November 28, 2016.  Due to several concerns CMS received from Part D plans, CMS has made some changes to the process to assist plans in completing the data request: 

  1. CMS will not begin the request for data until January 9, 2017.
  2. The time period of data that will be requested is February-April 2016.
  3. Data submission excludes the following plans- PACE, MMP, MSA, and Employer/Union Only Direct and 1833 Cost contracts.

Action: Informational to PACE plans as PACE is excluded from this data submission.

 

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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