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

Release of the Contract Year (CY) 2019 Bid Upload Functionality in HPMS – Dated 5/4/2018

Summary: CMS released the Contract Year (CY) 2019 bid upload functionality in HPMS Bid Submission module.  Plans should begin the 2019 bid submission upload requirements by June 4, 2018. A list of the required components with detailed information for a complete bid submission is included.

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


Payment Year (PY) 2015 Final Reconciliation and Overpayment Recovery – Dated 5/4/2018

Summary: CMS will rerun PY 2015 risk scores and the deadline to submit PY 2015 deletions to the Risk Adjustment Processing System will be on June 7, 2018 at 8PM EDT.  The MARx payment adjustments as a result of the risk score rerun will be identified on the Monthly Membership Data File. 

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


CMS’ Encounter Data Processing System (EDPS) Infrastructure Transition – UPDATE –Dated 5/4/2018

Summary: As previously announced, CMS is making infrastructure changes to the EDPS to maintain and improve the system.  The infrastructure transition will begin on May 19, 2018 at 12AM EDT and will take about 3 weeks long.  During such time, the MAO-001 and MAO-002 reports will not be transmitted to plans for any encounter data submitted until after the transition period.  CMS will notify plans when the EDPS resumes the reports.

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


Release of the 2017 Medicare Part C and Part D Program Audit and Enforcement Report – Dated 5/8/2018

Summary: CMS released the 2017 Part C and Part D Program Audit and Enforcement Report.  The report provided information on the program audits, summary of 2017 audits, and the CMS’ enforcement actions taken.  A link to the report is also provided.

Action: Informational to PACE.  Refer to the attachment for complete details on the 2017 program audits.


Implementation of the Updated SCRIPT Standard – Dated 5/9/2018

Summary: CMS announced the new NCPDP SCRIPT Standard Version 2017171 and the retirement of the current NCPDP SCRIPT Version 10.6 for use of the Medicare Prescription Drug Benefit Program effective January 1, 2020.  CMS addressed concerns received from stakeholders related to the implementation of the new standard in the memo.

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


Process for Requesting an HPMS Crosswalk Exception for Contract Year (CY) 2019 – Dated 5/9/2018

Summary: CMS released guidance on the HPMS crosswalk exceptions process for CY 2019.  A listing of the crosswalk exceptions is provided.  Any plan crosswalk exception requests may be submitted in HPMS from June 5, 2018 through June 6, 2018 at 5PM ET.  A second round of crosswalk exceptions will be accepted in July.

Action: Informational to PACE.  Refer to the memo for additional details on the crosswalk exceptions process.


State Pharmaceutical Assistance Programs and AIDS Drug Assistance Programs – Dated 5/11/2018

Summary: CMS provided information to SPAPs and ADAPS related to the HPMS module, data sharing agreements, HPMS for new users, and the SPAP/ADAP attestation module to help SPAPs and ADAPs prepare for Calendar Year 2019.

Action: Informational to PACE.  


MBI Crosswalk Reminder – Dated 5/14/2018

Summary: CMS reminded plans to not share the MBIs directly with the plan enrollees.  The MBIs provided on the crosswalk file are only meant to be used for data submission to CMS system.

Action: Applicable to PACE.


Medicare-Medicaid Plan Guidance on the Uniformity Requirement and Primarily Health Related Supplemental Benefits for Contract Year (CY) 2019 Submissions – Dated 5/15/2018

Summary: CMS provided additional MMP-guidance regarding submission of benefits related to reinterpretation for the uniformity requirement.  Information contained in the memo augments guidance provided in the April HPMS memo.

Action: Informational to PACE.


Reminder of CY 2019 Plan Benefit Package and Additional Demonstration Drug (ADD) File Submission Deadlines for Medicare-Medicaid Plans (MMPs) – Dated 5/16/2018

Summary: CMS reminded plans that all plan benefit package submissions for CY 2019 are due no later than June 4, 2018.  MMPS must complete all the required components and submit by the deadline for the PBP submission to be considered complete.  Plans should make sure the appropriate personnel are available before and after the submission. MMPs are also required to submit an ADD file in HPMS after their PBP submission but no later than June 8, 2018.

Action: Informational to PACE.


Unacceptable Pharmacy Gag Clauses – Dated 5/17/2018

Summary: CMS reminded all plans to ensure their enrollees pay the lesser of the Part D negotiated price or copay, or are subject to CMS compliance actions.  Furthermore, any “gag clauses” within the plan or PBM’s pharmacy contract is unacceptable and is contrary to President Trump’s proposal in promoting drug price transparency and lowing drug prices.

Action: Applicable to PACE.  Refer to the memo for complete details.  Plans who have direct pharmacy contracts with a pharmacy should review their contracts to comply with this memo.


Important Date Reminders



June 4, 2018

Opioid Strategy Submission Requirement Deadline

June 29, 2018

2017 PDE Submission Deadline

June 30, 2018

2017 Direct & Indirect Remuneration (DIR) Submission Deadline

July 31, 2018

2014, 2015, and 2016 DIR Resubmission Deadline

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

Pharmastar Office Closed on Memorial Day

 The Pharmastar Administrative Office will be closed on May 28, 2018 in observance of Memorial Day.  As always, the Pharmastar pharmacy help desk will be available for your needs throughout the coming holiday at 888.298.7770.


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.

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.