Learn more about CMS Updates that may impact your PACE Plan. FEATURED UPDATE: Enrollment Guidance Changes for Contract Year 2018
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Learn more about CMS Updates that may impact your PACE Plan.

 

REMINDER: Process for Requesting an HPMS Crosswalk Exception for Contract Year (CY) 2018 – Dated 6/7/2017

Summary: Guidance is provided on the HPMS crosswalk exceptions process that is available to Medicare Advantage Organizations (MAO) and Prescription Drug Plan (PDP) sponsors for CY 2018.  The exceptions were listed in the April 3, 2017 announcement.  CMS would like to remind organizations that the ability to request a crosswalk exception for CY 2018 opens June 6, 2017 to June 9, 2017.

Action: Informational to PACE as PACE plans are not required to renew their contracts on a yearly basis compared to MA plans.  Additionally PACE plans do not submit a Part C bid.

 

Payment Year (PY) 2014 Overpayment Recovery – Dated 6/7/2017

Summary: For the PY 2014 risk score rerun, CMS announced the deadline to submit all PY 2014 deletions to the Risk Adjustment Processing System by Friday, July 7, 2017.  The sweep will occur as of July 7, with all deletions received by the deadline to be included in the risk score rerun and subsequent overpayment recovery.  

Action: Applicable to PACE, refer to the memo for additional details.  Information on submitting overpayment related to Risk Adjustments can be found in the memos referenced.

 

Risk Adjustment Data Validation Contract Audits for Payment Year (PY) 2014 – Diagnosis Deletion Period – Dated 6/7/2017

Summary: Center for Program Integrity is preparing for PY 2014 Risk Adjustment Data Validation (RADV) audits and is reminding plans of the diagnosis deletion period which will be the last chance for plans to delete diagnoses prior to the 2014 RADV audit.  Plans selected for the audit will be notified and further information about the audit will be forthcoming.

Action: Applicable to PACE, refer to the memo for complete details.

 

Encounter Data Software Releases – Dated 6/7/2017

Summary: CMS released information on the software improvements made to the systems that accept and process encounter data.  The improvements will be implemented from August 2016 through July 2017 and are as follow which may require plan action:

  1. TIBCO Translator Transition
  2. Updates to accept new Place of Service code 02 (“Telehealth”)
  3. Changes to Error Codes reported on MAO-002 Reports

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

 

MMP Provider and Pharmacy Directory Webinar Registration – Dated  6/8/2017

Summary: CMS provided MMPs with details for the upcoming Provider and Pharmacy Directory webinar on June 21, 2017.  

Action: Informational to PACE.  For individuals interested in participating, refer to the memo for additional details on how to register for the webinar.

 

Training Webinars Available for Self-Management Support and Geriatric-Competent Care – Dated 6/12/2017

Summary:  CMS released information on two upcoming webinars to train plans on how to improve the quality and delivery of care for dually eligible individuals: 

  • June 19, 2017- Peer-led Interventions to Activate Self-Management for Behavioral and Physical Health
  • June 28, 2017- Diagnosis and Treatment of Parkinson’s Disease 

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

 

Discontinuation of CMS Approval Process for C-SNP Pre-Enrollment Qualification Assessment Tool – Dated 6/12/2017

Summary: CMS will no longer require chronic condition special needs plans to seek CMS approval prior to using a Pre-Enrollment Qualification Assessment Tool.  MAOs are no longer required to submit these tools to CMS for approval.  The change is to go into effect immediately.

Action: Informational to PACE as this does not apply to PACE plans.

 

Registration Update: In-person Registration for CMS’ 2017 Programs of All-Inclusive Care for the Elderly (PACE) – Dated 6/15/2017

Summary: CMS reminds plans of the registration for the CMS 2017 PACE conference and webcast.  The in-person registration for foreign national visitors will close this week.  This is a hybrid event which offers participants the option to attend in person or view virtually via webcast.

Action: Informational to PACE.  For those interested in participating, refer to the email and attachment for additional information and how to register.

 

Model Enrollment Form Changes for Contract Year 2018 – Dated 6/15/2017

Summary: CMS provided technical edits to the model enrollment form exhibits in the Medicare Managed Care Manual and Medicare Prescription Drug Benefit Manual to address the operational changes resulting from the shift from HICN to MBI.  CMS recommend plans to make edits to their enrollment mechanisms so plans can accurately collect the Medicare number, whether it is a HICN or MBI. Edit changes will need to be made before April 2018.

Action: Applicable to PACE as this is part of the Social Security Number Removal Initiative. Refer to the memo for complete details.  

 

Enrollment Guidance Changes for Contract Year 2018 – Dated 6/15/2017

Summary: CMS provided enrollment processing changes to the Medicare Managed Care Manual and Medicare Prescription Drug Benefit Manual for contract year 2018 to help plans process enrollment requests more efficiently with the MBIs.

Action: Applicable to PACE as this is part of the Social Security Number Removal Initiative.  Refer to the memo for complete details.

 

Request for Timely Enrollment Updates

Pharmastar is asking plan Enrollment Departments to send us member enrollment/disenrollment and changes, if it is available, as timely as possible due to the 1st of July falling on a weekend.  Please forward this information on to your organization’s Enrollment Department along with the Pharmastar email address: pstar@pharmastarpbm.com, as any enrollment information received after 4:00 PM CST on June 30th will not be loaded until Monday, July 3rd and after the upcoming holiday.

 

July 4th Holiday

The Pharmastar Administrative office will be closed on Tuesday, July 4th.  As always the Pharmastar Help Desk will be available for your needs throughout the coming holiday at 888.298.7770.

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