Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Qualifying Health Coverage Reporting for Medicare Beneficiaries
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Learn more about CMS Updates that may impact your PACE Plan.

Christmas and New Year's Hours

The Pharmastar Administrative Office will remain open during normal business hours on December 23rd and December 26th, as well as December 30th and January 2nd. As always, the 24/7 Pharmastar help desk will remain open for your needs throughout the coming holiday at 888-298-7770.

 

2017 Draft PACE Audit Protocols – 30-Day Comment Period- Dated 12/6/2016

Summary: CMS announced that the 2017 draft Audit Protocol for PACE has been released for a 30-day comment period as part of the PRA approval process. Instructions for providing comments can be found by visiting the link provided. The comment period closes on January 3, 2017.

Action: Applicable to PACE. Comments can be provided before 01/03/2017 by following the link within the memo. 

 

PACE Updates- Dated 12/6/2016

Summary: This is a reminder for organizations interested in submitting an initial PACE application during this quarterly submission window that they must hit “final submit” in HPMS on their application on December 30, 2016 to receive a confirmation email. Failure to hit “final submit” will result in an incomplete application, and a new initial application must be submitted during an upcoming submission window. Information is also provided regarding SAE applications as well as a reminder regarding a PACE Change of Ownership (CHOW).

Action: Applicable to PACE. Please refer to the email for deadlines as well as specific instruction. Reference can also be made to the December 11, 2015 HPMS memo “2016 PACE Application Guidance” for further instructions.

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Fall 2016 Past Performance Results Available in HPMS- Dated 12/7/16

Summary: This email is to inform that the results of CMS’ review of organizations’ performance for the period of July 2015 through August 2016 are now available in HPMS. For organizations offering both Part C and Part D, there are separate C and D results. Viewing instructions for results are included in the memo as well as information regarding past performance. 

Action: Informational to PACE.

 

Electronic Prescribing Incentive Program 2014 Payment Adjustment File- Dated 12/7/2016

Summary: This memo provides guidance to MAOs on how they may adjust their payments to non-contract providers who were not successful electronic prescribers under the eRx Incentive Programs for program year 2014. A link for additional information about the eRx Incentive Program can be found within the memo.

Action: Informational to PACE.

 

Physician Quality Reporting System 2015 Payment Adjustment File- Dated 12/7/2016

Summary: This memo provides guidance to MAOs in determining whether their payments to non-contract providers for services furnished in 2015 may be adjusted to account for negative payment adjustments under the Physician Quality Reporting System (PQRS).

Action: Informational to PACE.

 

Physician Quality Reporting System 2014 Payment File and 2014 MOC Eligibility File- Dated 12/7/2016

Summary: This memo provides guidance to MAOs in determining whether their payments to non-contract providers should be adjusted to account for PQRS incentive payments earned in program year 2014.

Action: Informational to PACE.

 

Medicare Outpatient Observation Notice (MOON) (CMS-10611)- Dated 12/8/2016

Summary: This memo announces the availability of the OMB-approved standardized MOON, form CMS-10611. All hospitals and CAHs are required to provide this notification no later than March 8, 2017. Instructions including the notice can be found by clicking the link within the memo.

Action: Informational to PACE.

 

Request for Part D Coverage Gap Discount Program Updated TPA Contact Information- Dated 12/8/2016

Summary: Part D pharmaceutical manufacturers and sponsors are required to identify contact persons for the CGDP which is then entered into the Contract Management module of HPMS. The memo is a reminder to periodically review this information and to request that contact information in the HPMS Contract Management module be reviewed and updated at this time, if necessary. 

Action: Informational to PACE.

 

Special Open Door Forum: Part D Appeals Process- Dated 12/12/2016

Summary: CMS is hosting a Special Open Door Forum on December 20, 2016 in which they are seeking input on key aspects of the current Part D appeals process. A link to information about the Part D appeals process as well as call in information can be found within the memo.

Action: Informational to PACE.

 

CY 2016 QIP Annual Update Training Reminder- Dated 12/12/2016

Summary: This is a reminder to MAOs and MMPs that CMS will hold the CY 2016 QIP Annual Update Training on 12/13/2016. Access information to the webinar is listed within the memo.

Action: Informational to PACE.

 

CORRECTED WEBEX LINK – CY 2016 QIP Annual Update Training Reminder- Dated 12/13/2016

Summary: This is a correction to the WebEx link listed in the email titled “CY 2016 QIP Annual Update Training Reminder” dated 12/12/2016.

Action: Informational to PACE.

 

Reopening of the 2011 Final Part D Payment Reconciliation- Dated 12/13/2016

Summary: This memo addresses the completed calculations for the reopening of the 2011 Final Part D Payment Reconciliation. Sponsors will also receive the Part D Exclusion from Reconciliation Report which was described in the 01/06/2014 memo “Reconciliation PDE Exclusion Process, as well as the 04/16/2014 memo “Updates to the Reconciliation PDE Exclusion Process. The payment reconciliation reports for reopening will be available 12/14/2016. Information regarding the reopening process as well as the appeals process can also be found within the memo. 

Action: Applicable to PACE. Please review the memo for details.

 

Qualifying Health Coverage Reporting for Medicare Beneficiaries- Dated 12/15/2016

Summary: In conjunction with the Individual Shared Responsibility provision requiring individuals to have QHC, the Affordable Care Act is requiring health insurance issuers to report to the IRS information about the type and period of coverage, and supply those individuals with statements containing this information.  CMS will be mailing notices to the beneficiary populations listed within the memo from late-December through January. 

Action: Applicable to PACE. Members inquiring about Medicare as QHC, including the Form 1095-B mailed by CMS can be referred to 1-800-MEDICARE (TTY: 1-877-486-2048) or Medicare.gov.

 

Release of the Final Civil Money Penalty Methodology- Dated 12/15/2016

Summary: Attachments are included in regards to the final Civil Money Penalty (CMP) methodology released by CMS. This is a revision to the proposed CMP methodology released 09/13/2016 in response to comments submitted. CMS will begin applying this methodology to address deficiencies relating to a sponsor’s administration of the Medicare Part C and D benefits for the 2017 CY.

Action: Informational to PACE.

 

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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