Learn more about CMS Updates that may impact your PACE Plan. FEATURED UPDATE: CY 2018 Formulary Information
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Learn more about CMS Updates that may impact your PACE Plan.

Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model – Dated 1/12/2018

Summary: CMS released the Advance Notice of Methodological Changes for CY 2018 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model on December 27, 2017.  A stakeholder call will be held on January 16, 2018 to discuss the publication.  CMS will continue to use the same risk adjustment model for PACE payments in PY 2019 as it has been since PY 2015.

Action: Informational to PACE.

 

REMINDER: Health Plan Management System (HPMS) Customer Satisfaction Survey for External HPMS Users – Dated 1/8/2018

Summary: CMS released the annual HPMS customer satisfaction survey.  All external HPMS users are invited to participate.  Feedback period will run from January 8, 2018 through January 17, 2018 until 5 PM EST.  The survey website is accessible via the internet and HPMS access is not required.

Action: Informational to PACE.  For individuals who would like to participate, refer to the memo for complete details.

 

Conference Call – Advance Notice of Methodological changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model – Dated 1/16/2018

Summary: CMS announced a second conference call related to the publication of the Advance Notice of Methodological Changes for CY 2018 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model to provide an additional opportunity for stakeholders to ask questions. Details on the call will be forthcoming.

Action: Informational to PACE.

 

Contract Year 2019 Model of Care Submission Training – Dated 1/17/2018

Summary: CMS announced the CY 2019 Model of Care submission training for Medicare Advantage organizations offering Special Needs Plans.  Training calls will be held on January 23, 2018 and January 25, 2018.  Model of Care submissions are due to CMS by February 14, 2018. 

Action: Informational to PACE as the Model of Care training is directed at Special Needs Plans and Medicare-Medicaid Plans.

 

Part D Transition Monitoring Program Analysis (TMPA) – Dated 1/17/2018

Summary: CMS provided an overview of the CY 2017 TMPA results and details regarding the CY 2018 TMPA.  Part D sponsors that are selected for the CY 2018 analysis will be notified and provided with additional information.  Participating sponsors selected will need to upload the Rejected Claims Files on or about February 12, 2018 through February 16, 2018.

Action: Informational to PACE as only PACE plans that submit a Part D formulary via HPMS will be included in the selection for the analysis.

 

Advance Announcement of the February 2018 Software Release – Dated 1/17/2018

Summary: CMS announced the planned release of system changes scheduled for February 2018. The changes will include the following:

  • Medicare Beneficiary Database Suite of Systems (MBDSS) Notification of the Medicare Beneficiary Identifier (MBI) to External Partners
  • New Medicare Card Project – MARx Changes

Action: Applicable to PACE. Refer to the memo for complete details and items that are applicable to your plan.

 

Medicare Advantage Value-Based Insurance Design Model Test – Update to the Request for Application for CY 2019 – Dated 1/18/2018

Summary: CMS announced changes made to the Value-Based Insurance Design Model in Section 2.2.3 – Marketing and Communications of the Request for Applications (RFA) for CY 2019.  The updated RFA and further information on the model is located on the Model website.

Action: Informational to PACE as PACE is not allow to participant in the VBID Model.

 

Contract Year 2019 Benefit Package Testing – Dated 1/19/2018

Summary: CMS used the comments and feedback from the summer 2017 PBP lessons to implement changes to the PBP software for CY 2019.  Beta testing is being conducted to ensure all aspects of the CY 2019 PBP software works as designed.  A request for assistance in the final testing of the CY 2019 PBP will take place on January 22, 2018 through February 2, 2018.

Action: Informational to PACE plans as PACE do not create their own Plan Benefit Package as it is set by CMS and do not have to test their Plan Benefit Package.  

 

UPDATES – 2018 Medicare Part D Overutilization Monitoring System – Dated 1/19/2018

Summary: CMS released updates to the Medicare Part D Overutilization Monitoring System (OMS) for the January 2018 release, including the revisions to the OMS criteria announced in the finalized 2018 Final Call Letter.  The updates will be incorporated into the next quarterly OMS reports, available on January 31, 2018.

Action: Applicable to PACE plans as PACE are not exempt from the OMS reporting.  Refer to the memo for complete details and how to access the Patient Safety Analysis Web Portal on Acumen.

 

Model of Care Training – Dated 1/22/2018

Summary: The planned CMS Model of Care trainings schedule for January 23 and January 25 have been postponed.

Action: Informational to PACE as the Model of Care training is directed at Special Needs Plans and Medicare-Medicaid Plans.

 

Rescheduled- New Dates for Contract Year 2019 Model of Care Submission Training – Dated 1/24/2018

Summary: CMS announced the CY 2019 Model of Care submission training for Medicare Advantage organizations offering Special Needs Plans.  Training calls will be held on January 30th and February 1st.

Action: Informational to PACE as the Model of Care training is directed at Special Needs Plans and Medicare-Medicaid Plans.

 

Provider Directory Review – Dated 1/24/2018

Summary: The report and data on the accuracy review of Medicare Advantage plans’ online provider directories can be found in the link provided in the email.

Action: Informational to PACE as PACE plans do not follow the MAPD marketing guidelines.

 

CY 2018 Formulary Information – Dated 1/24/2018

Summary: CMS released the process for submitting formulary updates for CY 2018.  Sponsors are reminded that the earliest effective date to implement approved negative formulary changes is March 1, 2018.  Negative formulary change requests could be submitted via HPMS NCR beginning January 1, 2018. Only approved negative changes may be implemented.

Action: Applicable to PACE plans that maintains and submits a formulary to CMS.  Refer to the memo for complete dates on the formulary update process.

 

2019 Advance Notice of Methodological Changes for Calendar Year (CY) 2019, Part 1: Medicare Advantage CMS-HCC Risk Adjustment Model Conference Call – Dated 1/24/2018

Summary: CMS announced the conference call detail related to the publication of the Advance Notice of Methodological Changes for CY 2018 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model to provide an additional opportunity for stakeholders to ask questions. The conference call will be held on January 26, 2018.

Action: Informational to PACE. 

 

Medicare Advantage Value-Based Insurance Design Model – CY 2019 Application Deadline Extended until January 31st 5PM EST – Dated 1/25/2018

Summary: CMS extended the deadline for the Medicare Advantage Value-Based Insurance Design (VBID) Model CY 2019 to January 31st.  

Action: Informational to PACE as PACE is not allow to participant in the VBID Model.

 

Important Date Reminders

Date

      Item

January 2018

Sensipar- ESRD Treatment must be included in the ESRD PPS & no longer payable under Part D benefit.

April 1, 2018

Medicare Diabetes Prevention Program services to be covered for eligible Medicare beneficiaries.

April 2018

New Medicare Card (Formerly known as SSNRI) to Begin

January 2019

Enforcement Date for the Prescriber Enrollment Requirement

*Subject to change, forthcoming information to be release by CMS.

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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