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

CGDP Preliminary Labeler Code Changes for Calendar Year 2018 – Dated 3/24/2017

Summary:

CMS will update the list of participating manufacturer labeler codes for the Coverage Gap Discount Program by January 1, 2018.  The updates include the following changes:

Additions:

69482    Encore Dermatology, Inc.

25799    Intarcia Therapeutics, Inc

70363    Cutanea Life Sciences, Inc.

70437    Puma Biotechnology, Inc.

70842    Melinta Therapeutics, Inc.

70539    Radius Health, Inc.

61894    Symplmed Pharmaceuticals

69853    Portola Pharmaceuticals, Inc.

69051    Profounda, Inc.

69468    Wellstat Therapeutics Corporatio

70436    Slate Run Pharmaceuticals, LLC.

66220    Cumberland Pharmaceuticals Inc.

55494    Duchesnay USA, Inc.

70482    Adamas Pharmaceuticals Inc.

55466    Neolpharma Inc

71090    Strongbridge US Inc

70720    TerSera Therapeutics 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 will make the necessary software adjustments to accommodate for the updated codes in CY 2018.  

 

Release of the HPMS Fiscal Soundness Module – Dated 3/24/2017

Summary: CMS released the Fiscal Soundness Module (FSM) and the reporting requirements for all types of Medicare Part D plans, including PACE.  PACE plans are excluded from following the date deadline provided in the memo, but must submit its annual audited financial statements to CMS no later than 180 days after the organizations fiscal year ends.

Action: Applicable to PACE.  Refer to the memo for additional guidance.  A filing instructions attachment is also included in the email.

 

2017 Medicare Part Low-Income Subsidy (LIS) Income and Resource Standards – Dated 3/28/2017

Summary: CMS attached tables within the memo for the 2017 Poverty Guidelines for individuals who apply for the low-income subsidy (LIS) for Medicare Part D.  CMS is required by law to update the income and resource limits each year.

Action: Applicable to PACE plans.  Refer to the memo for additional information.

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Advance Announcement of the May 2017 Software Release – Dated 3/28/2017

Summary:

CMS continues to implement software improvements to the enrollment and payment systems that support Medicare Advantage and Prescription Drug programs (MAPD).

The plan released of systems changes scheduled for May 2017 include the following:

  • Direct Billing of Retroactive Late Enrollment Penalty
  • Determining Medicaid Statuses
  • Part C and D Risk Factors for the Program of All-Inclusive Care for the Elderly (PACE)
  • Social Security Number Removal Initiative – MARx Functionality
  • Risk Adjustment Suite of Systems 2016 Final Model Output Report Maintenance
  • Supplemental Data on the MAO-004 Report 

Action: Applicable to PACE plans.  Refer to the memo for further information on the release systems changes.

 

Coverage Gap Discount Program: April Participating Labeler Code Update – Dated 3/28/2017

Summary:

CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program by April 1, 2017.  The updates include:

Added:

64370 Pierre Fabre Pharmaceuticals, Inc.

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.

 

Medicare Advantage Prescription Drug System (MARx) April 2017 Payment – INFORMATION – Dated 3/29/2017

Summary:

The memo provides information related to the April payment:

  • CY2015 Coverage Gap Discount (CGD) Reconciliation
  • Overpayments Resulting From Cross-Reference Merge Processing
  • Missing January 2016 Payments

Action: Informational to PACE.  Refer to the memo for information that may be applicable to your plan.

 

Guidance for the Part D Payment Reconciliation Reopening for Calendar Year 2012 – Dated 3/29/2017

Summary: CMS will reopen the 2012 Part D payment reconciliation with Part D sponsors.  To be considered in the 2012 reopening, accepted PDE data must be received by September 29th.  For any outstanding changes to the 2012 DIR data, CMS will open the window for resubmission of the 2012 DIR reports and must be received by July 31st

Action: Applicable to PACE.  Refer to the memo for complete details on the reopening and related deadlines and exclusions.

 

Upcoming NCPDP Hospice Survey – Dated 4/3/2017

Summary: NCPDP distributed a Hospice Survey to Compliance Officers at the Part D plans and received a lower than expected response rate from the plans.  CMS request plans to respond to the survey as soon as possible. 

Action: Informational to PACE.

 

Actuarial User Group Calls – Dated 4/3/2017

Summary: CMS Office of the Actuary will host weekly calls beginning on Thursday, April 13th to provide further guidance on completing the Bid Pricing Tools and respond to questions on the Contract Year (CY) 2018 bids.

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

 

Announcement of Calendar Year (CY) 2018 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies, Final Call Letter and Request for Information – Dated 4/3/2017

Summary: CMS released the final draft call letter for Calendar Year 2018, including other information and key changes from the Advance Notice.

Action: Review the call letter for information applicable to Part D/PACE.  

 

Applicability of CY 2018 Final Call Letter Provisions to Medicare-Medicaid Plans – Dated 4/4/2017

Summary: CMS released additional guidance regarding the CY 2018 Final Call Letter that was issued on April 3, 2017 to specify the items applicable to Medicare-Medicaid Plans.

Action: Informational to PACE.

 

Attestation for the Reopening of the 2017 Final Part D Reconciliation for Calendar Year (CY) Employer Group Waiver Plans (EGWPs) – Dated 4/4/2017

Summary: CMS announced the reopening of the 2014 Final Part D Reconciliation for CY Employer Group Waiver Plans (EGWPs).  All EGWPs must sign the Attestation of Data Relating to CMS Payment to a Medicare Part D Sponsor by April 17, 2017.

Action: Not applicable to PACE as this is directed only towards EGWPs.

 

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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