Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Reliability Testing of New Quality Measures for the PACE Program
Not rendering correctly? View this email as a web page here.

Pharmastar-CMS-Email-Header.gif

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

Phase III Version 3 MAO-004 Reports Distribution Update – Dated 2/23/2018

Summary: CMS released additional information on the distribution of the Phase III Version 3 MAO-004 reports and how to access the reports.

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

 

Addendum to the Announcement of the February 2018 Software Release – dated 2/23/2018

Summary: CMS provided clarification on the New Medicare Care Project for the Medicare Beneficiary Database Suite of Systems and the Coordination of Benefits (COB) file.  

Action: Applicable to PACE.  Refer to the memo for complete details on the two New Medicare Card Project updates.

 

Civil Money Penalty Enforcement Actions for 2017 Program Audits – Dated 2/26/2018

Summary: CMS published the Civil Money Penalties (CMPs) imposed on Part C and Part D Sponsors for violations of Medicare Parts C and D requirements found during the sponsors’ 2017 Program Audit.  CMP notifications that were made to the sponsors are made public to provide transparency and a fair comparison of sponsors who receive the actions.  All the notices are posted on the Part C and Part D Enforcement Actions webpage.  

Action: Informational to PACE.

 

Update to HEDIS 2018 Patient -Level Data Memo Dated December 26, 2017 – Dated 2/26/2018

Summary: CMS updated the patient-level file specifications described in the HPMS HEDIS 2018 Patient-Level Data memo released in December to increase the field lengths of the last four variables in the patient record.  Updated versions of the instructional documents are available on the link provided.

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

 

Registration Open: CMS 2018 MA & PDP Spring Conference & Webcast & MA and PDP Audit & Enforcement Conference & Webcast Announcements- Updated Save the Date Announcement – Dated 2/27/2018

Summary: CMS released information on the upcoming CMS conferences & webcasts.  Registration is now open for both events held on May 9, 2018 and May 10, 2018.  In-person registration will close on April 23, 2018.  Agenda topics for both events are included.

Action: Informational to PACE. For individuals interested in participating, refer to the attachments for complete details and how to register.

 

Addendum Update to the Announcement of the February 2018 Software Release – Dated 2/28/2018

Summary: CMS released further updates on files that will now contain the active MBI field effective February 17 which includes:

  • Auto Assignment Address (PDP) Notification File
  • MA Full Dual Auto Assignment Notification File
  • No Rx File

Action: Informational to PACE.

 

Pharmastar's Outstanding Services Streamline Your Day-to-Day

 

Coverage Gap Discount Program: March Participating Labeler Code – Dated 2/28/2018

Summary: CMS list of participating manufacturer labeler codes will be updated by March 1, 2018 to include the following:

27808 Tris Pharma

52246 ParaPRO LLC

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.

 

CY 2019 Formulary Reference File (FRF) – Dated 2/28/2018

Summary: In the CY 2019 Draft Call letter, CMS announced the intent of removing drugs that are commonly covered under Medicare Part B or in the hospital setting from the Part D FRF.  A draft of the CY 2019 FRF to reflect this review is available for download on the link provided.  Plans who believes that certain RXCUIs should be maintained on the FRF can complete and submit the worksheet to CMS by March 9, 2018.

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

 

Prescription Drug Event (PDE) Reports and PDE Analysis Reporting Initiatives Updates for the New Medicare Card Project – Dated 3/1/2018

Summary: Starting April 1, 2018, all error reports and outlier analysis reports available through the PDE Reports and PDE Analysis portals on Acumen will rename the HICN field to “Medicare beneficiary identifier”.  The beneficiary’s MBI will be populated when it is available on the reports.

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

 

Medicare Advantage/Prescription Drug System (MARx) March 2018 Payment – INFORMATION – Dated 3/2/2018

Summary: CMS released information about the March payment which is scheduled for March 1, 2018 and may require plan action on the following:

  • Frailty Factor Update
  • Coverage Gap Discount (CGD) Invoice Offsets
  • New Medicare Card Project – MARx Changes

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

 

Reliability Testing of New Quality Measures for the PACE Program – Dated 3/2/2018

Summary: CMS and its contractor, Econometrica, Inc, are testing potential quality measures for the PACE program.  A Econometrica personnel will contact the plans who are selected over the next several weeks to arrange testing and data collection which will occur between April and May 2018.

Action: Applicable to PACE.  Questions regarding the testing or recruitment process can be sent by email to PACEAdmin@Econometricalnc.com.

 

Updated Complaints Tracking Module (CTM) Standard Operating Procedures (SOP) – Dated 3/2/2018

Summary: There will be technical system enhancements to the Complaints Tracking Module on April 16, 2018.  Notable changes for plan users are listed.  The Complaints Tracking Module Plan Standard Operational Procedures is included for plan review.

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

 

Release of the new HPMS PACE Quality Monitoring Module and Training Announcement – Dated 3/7/2018

Summary: CMS will release the HPMS PACE Quality Monitoring Module on April 2, 2018 and combine the PACE Level I and II data which will be known as “PACE Quality Data”.  PACE must use the module to report all Quarter 2 PACE Quality Data.  Training on the new module and reporting requirements will be on March 22, 2018.  

Action: Applicable to PACE.  Refer to the email for compete details regarding the training.

 

Important Date Reminders

Date

      Item

March 4, 2018

HICN to MBI Crosswalk File available via MARx.

April 1, 2018

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

April 1, 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.

iStock_85328599_MEDIUM.jpg
Questions?
A real person always answers the phone at Pharmastar.
Sometimes the most important questions happen after normal business office hours. That’s why you can always talk to one of our pharmacy technicians 24/7/365 simply by calling us at (888) 298-7770.