Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Encounter Data Software Release
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Learn more about CMS Updates that may impact your PACE Plan.

Corrected – Updated Complaints Tracking Module (CTM) Standard Operating Procedures – Dated 3/9/2018

Summary: CMS will make technical system enhancements to the CTM effective April 16, 2018.  An update to the CTM Plan Standard Operational Procedures is provided to clarify the guidance. In addition, CMS revised the current file layout to change the field label from HICN/MBI to Bene_Identifier.  

Action: Informational to PACE.

 

Encounter Data Software Release – Dated 3/12/2018

Summary: CMS provided information on a new informational edit 22465 which relates to non-medically justified dialysis treatments reported on MAO-002 reports.  The new edit will be implemented on March 30, 2018.  Furthermore, the MAO-001 reports will be updated beginning April 1, 2018 to accommodate the New Medicare Card Project. 

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

 

Updates to Payment Years (PY) 2017 and 2018 Model Output Report (MOR) – Dated 3/12/2018

Summary: CMS released the Model Output Report (MOR) to plans to identify the Hierarchical Condition Codes (HCCs) used to calculate risk scores for each beneficiary.  For PY 2017 and PY 2018, risk scores for PACE plans continue to be calculated based on diagnoses from RAPS, encounter data and FFS in equal measure and will have specific MOR record types to report HCCs from any of these three sources. 

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

 

Long-Term Institutionalized (LTI) Resident Report – Dated 3/13/2018

Summary: The first 2018 LTI Resident Report will be distributed to plans on March 13, 2018.  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.

 

Request for Stakeholder Input: Implementing the Dual Eligible Special Needs Plans (D-SNPs) Provisions of the Bipartisan Budget Act of 2018 (Public Law No. 115-123) – Dated 3/13/2018

Summary: CMS is looking for comments from plans to help inform CMS’ next steps related to unified Dual Eligible Special Needs Plans grievance and appeals processes and new integration standards.  

Action: Informational to PACE. 

 

 Medicare-Medicaid Capitated Financial Alignment Model Core Quality Withhold Technical Notes for Demonstration Years 2 through 5 – Dated 3/14/2018

Summary: Medicare-Medicaid Plans will be evaluated in accordance with the final Medicare-Medicaid Capitated Financial Alignment Model Core Quality Withhold Technical Notes for Demonstration Years 2 through 5 which has been released.

Action: Informational to PACE. This applies to Medicare-Medicaid Plans only.

 

2018 Medicare Part D Low-Income Subsidy (LIS) Income and Resource Standards – Dated 3/14/2018

Summary: As required by law, CMS has updated the income and resource standards for individuals who apply for the low-income subsidy (LIS) for Medicare Part D.  The 2018 Poverty Guidelines and methodology used to update the resource limits is attached.  The new income and resource standards are to be applied to all LIS applications filed on or after January 1, 2018.

Action: Informational to PACE.

 

Contract Year 2018 Monitoring of Medicare-Medicaid Plan Provider and Pharmacy Directories – Updated – Dated 3/15/2018

Summary: CMS provided information about the status of the Contract Year (CY) 2018 Provider and Pharmacy Directory monitoring and shared some of the findings from the monitoring to help Medicare-Medicaid Plans on their CY 2019 directories.

Action: Informational to PACE.

 

Annual Request for Part D Payment Reconciliation Contact Information – Dated 3/16/2018

Summary: CMS request all plans who had an active contract in 2017 to provide contact information for individual(s) authorized to discuss reconciliation issues as well as issues related to DIR via HPMS by April 2, 2018.  All plans who were active in 2017 but no longer in 2018 will need to complete a form and send via email to the Reconciliation Support Contractor.  Plans are asked to limit the number of contacts for each to no more than two persons per parent organization.  

Action: Applicable to PACE.  Refer to the memo for complete details on this request and how to submit the information.

 

Update: CMS’ 2018 MA & PDP Spring Conference & Webcast & MA and PDP Audit & Enforcement Conference & Webcast Announcements – Dated 3/19/2018

Summary: CMS made a few changes to the in-person registration process for both upcoming conferences to comply with CMS’ Security requirements.  In-person registration closes on April 23, 2018 at 6 PM EST.

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

 

Phase III Version 3 MAO-004 Report Distribution for Inactive Contracts – Dated 3/21/2018

Summary: CMS announced the distribution of MAO-004 reports for inactive contracts to be released in April.  The reports will be generated for inactive contracts if that contract submitted accepted encounter data records for dates of service on or after January 1, 2014 and the organization currently has an active EFT connection to CMS.  

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

 

Closing the Drug Data Processing System (“”DDPS”) for benefit year 2011 – Dated 3/22/2018

Summary: CMS announced the closing of PDE data with dates of service for benefit year 2011.  DDPS will reject PDE data with DOS for 2011 on July 1, 2018 with a PDE edit code 788.

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

 

Important Date Reminders

Date

      Item

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.

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