Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Revised Medicare Prescription Drug Coverage and Your Rights
Not rendering correctly? View this email as a web page here.

Pharmastar_CMS_Header

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

Release of the 2019 Service Area Verification Functionality – Dated 4/20/2018

Summary: Part D sponsors can begin reviewing their entire contract service area and applicable attributes in the HPMS Contract Year 2019 Service Area Verification (SAV) functionality.  Plans must concur or non-concur by the June 4, 2018 bid submission.  CMS encourage plans to complete the SAV as soon as possible to have enough time to resolve any problems by the deadline.

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

 

2018 PACE Audit Updates – Dated 4/23/2018

Summary: CMS released an overview of the PACE audit process improvements and reminders for 2018.  The first PACE Annual Report will be released later this year to provide an overview of the 2017 CMS PACE audits including: common conditions identified, audit scores, and lessons learned.  Any questions about the PACE audit can be sent to CMS’s centralized point of contact as provided in the memo.

Action: Applicable to PACE.  Refer to the memo for complete updates on the PACE Audit for 2018.

 

May 2018 Updates to the Drug Data Processing System (DDPS) – Dated 4/23/2018

Summary: CMS will make the following changes to the DDPS with the updates to go into effective on May 13, 2018.

  • PDE Error Code 752- Reject PDEs from terminated and settled contracts
  • PDE Error Code 880- Modify reject code to allow for a one cent rounding margin

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

 

Save the Date – Medicare-Medicaid Plan Provider and Pharmacy Directory Call – Dated 4/23/2018

Summary: The Medicare-Medicaid Coordination Office will host a Provider and Pharmacy Directory call for MMPs on June 13, 2018 to reinforce ongoing burden reduction efforts and aid MMPs in preparing for their Contract Year 2019 directories.

Action: Informational to PACE.

 

Guidance for the Part D Payment Reconciliation Reopening for Calendar Year 2013 – Dated 4/23/2018

Summary: CMS will perform a program-wide reopening for the 2013 Part D Payment Reconciliation. The reopening will include CY 2013 PDE data submitted and accepted through 1PM ET on September 28, 2018.  For 2013 DIR changes, CMS will open the gates in HPMS for the resubmission of the 2013 DIR reports for Payment Reconciliation from July 1- July 31, 2018.  CMS will continue to accept CY 2013 PDE data after the September 28th deadline; however, the data will not be considered in the reopening.

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

 

HPMS Training Section on CMS.gov – Dated 4/24/2018

Summary: CMS released new HPMS training resources related to the HPMS functionality.  The link to the training materials is provided and currently includes the following: HPMS Welcome Video, Formulary, and Plan Bids.

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

 

CY 2019 BPT Add-In File Version 2 – Dated4/24/2018

Summary: CMS released the new BPT add-in file version (v2) to the CY 2019 bid software.  HPMS will require the new version to be used when submitting a CY 2019 BPT.  To download the new add-in file, the path in HPMS is provided.

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

 

Contract Year (CY) 2019 Plan Benefit Package (PBP) Validation Error in Section C – Dated 4/24/2018

Summary: CY 2019 PBP software contains a validation error that impacts Section C data entry.  CMS will have a direct fix for impacted plans no later than April 27, 2018.  All PPO plans experiencing the validation issue with Section C must contact the HPMS Help Desk.

Action: Informational to PACE.

 

Medicare Advantage/Prescription Drug System (MARx) May 2018 Payment – INFORMATION – Dated 4/27/2018

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

  • CY2016 Coverage Gap Discount Reconciliation
  • May Software Release Update

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

 

Reinterpretation of the Uniformity Requirement – Dated 4/27/2018

Summary: CMS provided guidance for MA organizations and Section 1876 plans for preparing their 2019 plan bids with the reinterpretation of the Uniformity Requirement.  Under this reinterpretation, CMS determined that providing access to services tied to health status or disease state ensures similarly situated individuals are treated uniformly is consistent with the uniformity requirement in the MA regulations.

Action: Informational to PACE.  Refer to the memo for additional information on the reinterpretation of the Uniformity Requirement.

 

Contract Year 2018 Monitoring Parts C & D Reporting Website Access – Dated 4/27/2018

Summary: CMS informed plans of the continuation of the Part C and D Reporting Requirements through the Acumen, LLC Monitoring Parts C & D Reporting Initiative for CY 2018 and the expectations of plans in this process.  An overview of the initiative and required actions and timelines are included.  For user authorization access requiring changes or adding new users, instructions are provided.

Action: Informational to PACE as PACE is excluded from the Part C reporting requirement and waived of the Part D reporting requirements.

 

Spring 2018 Past Performance Results Available in HPMS – Dated 4/27/2018

Summary: The results of CMS’ review of organizations’ performance for the period of January 2018 through March 2018 are now available on HPMS.  For organizations offering both Part C and D, there are separate C and D results.  Viewing instructions for results are included.

Action: Informational to PACE as PACE is excluded from the performance analysis.

 

Reinterpretations of “Primarily Health Related” for Supplemental Benefits – Dated 4/27/2018

Summary: CMS provided guidance for MA organizations and Section 1876 plans for preparing their 2019 plan bids with the reinterpretation of “primarily health related” for supplemental benefits.  A list of allowable supplemental benefits resulting from expanding the definition of “primarily health related” is provided.

Action: Informational to PACE.

 

Application of the Merit-based Incentive Payment System (MIPS) Payment Adjustment to Medicare Advantage Out-of-Network Payments – Dated 4/27/2018

Summary: CMS provided guidance to Medicare Advantage Organizations regarding the application of the MIPS payment adjustment to payments on non-contract MIPS eligible clinicians.  

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

 

Discontinuation of the RAPS OPMT File Type – Dated 4/30/2018

Summary: CMS informed plans that as of July 6, 2018, RAPS will no longer accept or process the OPMT File Type.  Plans will receive an error message when an OPMT File is submitted.  The Production (PROD) File Type will be used for submitting Overpayment deletes.

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

 

CGDP Preliminary Labeler Code Changes for Calendar Year 2019 – Dated 4/30/2018

Summary: CMS released the anticipated labeler code changes covered under the CGDP for the CY 2019.  For CY 2018, plans should continue to rely on the monthly labeler code files that can be found on the link provided.  The below labeler codes are currently scheduled to be added on January 1, 2019. An updated list will be provided in August 2018.

25208 Medicure International

57841 RedHill Biopharma, Inc.

65628 CutisPharma Inc.

70709 Cycle Pharma

71045 Achaogen

71526 Versartis, Inc.

71565 Clearside Biomedical, Inc.

71571 Kala Pharmaceutical Inc.

71699 SK Life Science, Inc.

72028 Harmony Biosciences, LLC

72093 Ablynx, 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.

 

CMS’ Encounter Data Processing System (EDPS) Infrastructure Transition – Dated 5/1/2018

Summary: Due to the infrastructure transition for the CMS EDPS, encounter data reports generated by the EDPS will be pending towards the end of May. This includes the MAO-001 and MAO-002 reports.  CMS will re-initiate transmitting the reports for all pended data to submitters after the transition is completed. Detail and specific dates for the transition period will be forthcoming.

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

 

Revised Medicare Prescription Drug Coverage and Your Rights (CMS-10147) – Dated 5/2/2018

Summary: CMS released the revised OMB-approved standard notice, “Medicare Prescription Drug Coverage and Your Rights” (CMS-10147) (“pharmacy notice”).  The revised pharmacy notice is to be used no later than July 1, 2018 by all Part D plan sponsors’ network pharmacies when an enrollee’s prescription cannot be filled under the Part D benefit and the issue cannot be resolved at the point of sale.

Action: Informational to PACE.  Refer to the memo for complete details and the link to the notice and accompanying instructions for the pharmacy notice.

 

Deadline for Submitting Risk Adjustment Data for Use in Risk Score Calculation Runs for Payment Years 2018, 2019, and 2020 – Dated 5/3/2018

Summary: CMS released upcoming deadlines to submit risk adjustment data for use in calculating risk scores for Payment Years (PY) 2018, 2019, and 2020.  All risk adjustment data that will be included in the listed risk score runs need to be submitted by the “Deadline for Submission” as specified.

Action: Applicable to PACE.  Refer to the memo for the specific deadlines.

 

Corrected-May 2018 Updates to the Drug Data Processing System (“DDPS”)—Dated 5/3/2018

Summary: CMS made a correction to PDE Error Code 880.  The correction is on how the maximum allowable CGD amount is calculated.

Action: Informational to PACE.

 

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.