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

Enrollment Opportunities for Individuals Affected by Hurricane Matthew and the Sevier County Wildfire and Tornado Outbreak - Dated 12/16/2016

Summary: CMS announced that there will be an enrollment opportunity for Medicare beneficiaries who were prevented from submitting enrollment requests due to the Tennessee wildfires and tornadoes, as well as the flooding in North Carolina due to Hurricane Matthew. CMS encourages beneficiaries to make their enrollment choices by 12/31/2016. Individuals affected can enroll by calling 1-800-MEDICARE. TTY users should call 1-877-486-2048.

Action: Informational to PACE.


Change to Aggregate Annual Cap on Nominal Gifts to Medicare Beneficiaries - Dated 12/16/2016

Summary: CMS will be increasing the MA limit from $50 to $75 per year, effective immediately, and will be reflected in next year’s release of the Medicare Marketing Guidelines.

Action: Informational to PACE.

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Upcoming Health Plan Management System (HPMS) Complaints Tracking Module Redesign - Dated 12/16/2016

Summary: A redesigned CTM will be launched by CMS on March 18, 2017 to introduce improvements to the module’s user interface and functionality. The memo outlines the most significant changes in the redesign, and notes additional guidance that will be provided over the coming months. Please refer to the memo for details regarding this redesign.

Action: Applicable to PACE. PACE organizations are expected to monitor and adhere to changes. Please refer to the memo for details.


Reporting of Emergency Part C & D Issues for January 1, 2017 through January 3, 2017 - Dated 12/16/2016

Summary: Similar to previous years, CMS is establishing a Part C & D operations monitoring program for 01/01/17-01/03/17. Non-technical emergency issues should be reported via email to both as well as your CMS Account Manager, and should be done so immediately. Any issues after 01/03/17 should be reported directly to the CMS Account Manager. A MEDICARE and CTM holiday schedule is provided within the memo. Part D sponsors must also update their CEO and Emergency Contact information in HPMS by 5 PM ET on 12/28/2016 to reflect on-call coverage for 01/01/17.

Action: Not Applicable to PACE.


CY 2017 Medicare-Medicaid Plan Core Reporting Requirements - Dated 12/16/2016

Summary: CMS released the CY 2017 Medicare-Medicaid Capitated Financial Alignment Model Core Reporting Requirements. Please refer to the memo for a summary of substantive changes that were made as compared to the CY 2016 reporting requirements released on 08/10/2016. Questions can be directed to

Action: Informational as PACE is excluded from Part D reporting requirements.


Compliance and Enforcement Actions Related to Part D Auto-Forwards - Dated 12/16/2016

Summary: Part D sponsors are required to process coverage determinations and redeterminations and notify enrollees of these decisions within the timeframes established. Failure to do so will result in an adverse decision and the sponsor must “auto-forward” the request to the IRE within 24 hours of the expiration of the applicable adjudication timeframe. CMS will continue to increase the level and severity of the compliance and enforcement actions as noted in the Announcement of CY 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter- Dated 04/04/2016. 

Action: Informational as PACE is excluded from Part D reporting requirements.


Change to Aggregate Annual Cap On Nominal Gifts to Medicare Beneficiaries Applicable to Medicare-Medicaid Plans - Dated 12/19/2016

Summary: This email is to clarify that the information contained in a 12/16/2016 HPMS email, “Change to Aggregate Annual Cap on Nominal Gifts to Medicare Beneficiaries” is also immediately applicable to MMPs that use the MMG limits.

Action: Informational to PACE. 


2017 Display Measures - Dated 12/20/2016

Summary: The final display data have been posted in HPMS and will be posted publicly at CMS worked with NCQA in regards to the issues identified with the measure DMC24- this information can be found within the memo in addition to instructions for accessing the display data in HPMS.

Action: Informational to PACE.


Announcement of the February 2017 Software Release - Dated 12/20/2016

Summary: This memo details information regarding the planned software release scheduled for February 2017. This will focus on improving the efficiency of CMS systems as well as Plan processing. Please refer to the memo for additional information regarding this update.

Action: Applicable to PACE. Refer to memo for details regarding February 2017 Release changes. 


Special Open Door Forum: Part D Appeals Process, Solicitation for Additional Comments - Dated 12/22/2016

Summary: Due to technical difficulties, some participants were unable to speak during the Special Open Door Forum for Part D appeals on 12/20/2016. For those unable to join, did not have an opportunity to speak during the call, or those with additional feedback, please submit comments and suggestions for improvements to the Part D appeals process to by 12/29/2016.

Action: Informational to PACE.


Medicare Plan Finder (MPF) Plan Version of Out-of-Pocket Cost (OOPC) Model for CY 2017 - Dated 12/22/2016

Summary: An updated version of the 2017 OOPC model is now available for MAOs, 1876 Cost Plans, and Part D sponsors to use in calculating CY 2017 OOPC values. This is an update to the 05/20/2016 Plan Model version and will be referred to as the CY 2017 MPF Plan Version. CMS encourages stand-alone PDPs and MAOs to run their plan benefit structures through this updated OOPC model. Differences between the models as well as a link to the updated model can be found within the memo.

Action: Informational to PACE.


PACE Innovation Act Request for Information - Dated 12/23/2016

Summary: CMS released an RFI on 12/23/2016 seeking public input on potential adaptations of the model of care employed by PACE for new populations under the authority provided by the PACE Innovation Act (PIA). The RFI is available at CMS welcomes feedback, and all interested parties may submit comments electronically in PDF form before 5 PM EST on 02/10/2017 to

Action: Please refer to information contained in memo and submit any feedback by 5PM EST on 02/10/2017.


Medicare Advantage/Prescription Drug System (MARx) January 2017 Payment – INFORMATION - Dated 12/28/2016

Summary: Included in this memo is information about the January payment which is scheduled for receipt on 01/03/2017, as well as other payment related items. Items included in the memo are:

  • 2017 User Fees
  • Final 2015 Risk Adjustment Reconciliation: Second Iteration
  • 2011 Part D Reopening
  • Repayment of Quality Withhold Amounts to MMPs

Action: Informational to PACE.


Annual Benefit Year Closeout for the Coverage Gap Discount Program Invoicing Cycle - Dated 12/2/2016

Summary: This memo serves as a reminder of the upcoming closeout of the benefit year 2013 CGDP invoicing cycle. PDE records reporting gap discount amounts for benefit year 2013 that require submission, adjustment, or deletion for any reason must be submitted by 01/31/2017 as invoicing ends 37 months after the end of the benefit year. PDEs not submitted before 01/31/2017 should continue to be corrected for accurate reporting, but will not be invoiced for manufacturer payment if the PDEs report a gap discount amount. 

Action: Informational to PACE.


Changes to Payment Year (PY) 2017 Initial Model Output Report (MOR)

Summary: CMS has updated the layouts for MOR due to changes make to Risk Adjustment payment models. Specific changes apply to the creation of a new Part C MOR Record Type “D” and the Part D MOR Record Type 2. Note similar changes to the MOR for the 2016 Final payment, which will use a blend of risk scores calculated using both RAPS-based diagnoses and encounter data-based diagnoses. Further guidance regarding these changes will be provided in another communication.

Action: Not Applicable to PACE, but PACE should be aware of the changes made to the MOR reports.


Part D Transition Monitoring Program – Dated 12/29/2016

Summary: The transition monitoring program analysis (TMPA) is being continued by CMS for CY 2017 to evaluate Part D sponsors’ compliance with the transition requirements. This memo is to provide an overview of the CY 2016 TMPA results and details regarding the CY 2017 TMPA. A table of expected actions and corresponding deadlines are included in the memo.

Action: Not Applicable to PACE.


Updated Deadline for Submitting Risk Adjustment Data for Use in Final 2016 Risk Score Run and Data Use in Mid-Year 2017 Risk Score Run – Dated 12/29/2016

Summary: This is an update to the 04/27/2016 HPMS memo, “Deadline for Submitting Risk Adjustment Data for Use in Risk Score Calculation Runs for Payment Years 2016, 2017, and 2018” to notify parties of changes to the upcoming risk scores runs. The deadline to submit encounter data for use in calculating final Payment Year 2016 risk scores will be extended to 05/01/2017. The deadline for MY2017 risk scores remains 03/03/2017.

Action: Informational to PACE.


Coverage Gap Discount Program: January Participating Labeler Code Update – Dated 12/29/2016

Summary: CMS is updating the list of participating manufacturer labeler codes for the Coverage Gap Discount Program by 01/01/2017. Changes are listed within the memo and a link to the update is included.

Action: Informational to PACE.

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