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

Medicare Part C Reporting Requirements – 30 Day Comment Period – Dated 7/16/2018

Summary: CMS announced the opportunity for plans to comment on the proposed 2019 Part C Requirements document.  Comments can be submitted by August 13, 2018.  The link to the proposed document and instructions for submitting comments is provided.

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

 

CMS 2018 MA & PDP Fall Conference & Webcast – Dated 7/17/2018

Summary: CMS announced the registration opening for CMS’ Medicare Advantage & Prescription Drug Plan Fall Conference & Webcast.  The event will be held on September 6, 2018 from 9:30 AM – 4:30 PM EDT.  A listing of the session topics is included in the attachment.

Action: Informational to PACE.  For individuals interested in participating, refer to the email for complete details.

 

Part D Summary 2013 DIR Report for the 2013 Reopening – Submission Reminder – Dated 7/17/2018

Summary: CMS remind plans of the deadline for submitting the Summary 2013 DIR Report for the 2013 Reopening.  All plans who intend to submit the 2013 Summary DIR Report should submit no later than 11:59 PM PST on July 31, 2018.

Action: Applicable to PACE.  Plans who may need to resubmit a report for 2013 DIR should refer to the memo for complete details.  All plans active with Pharmastar for the entire CY 2013 will not need to submit.

 

Release of the 2017 Programs of All-Inclusive Care For the Elderly (PACE) Audit and Enforcement Report – Dated 7/18/2018

Summary: CMS released the 2017 PACE Audit and Enforcement Report. It is available to view by following the link provided in the email.

Action: Informational to PACE.  Refer to the email for the link to the report.

 

Medicare Communications and Marketing Guidelines – Dated 7/20/2018

Summary: CMS released the CY 2019 Medicare Communications and Marketing Guidelines on the Managed Care Marketing website.  A list of the highlights to the marketing guidelines is provided.

Action: Informational to PACE as PACE has its own marketing guidelines.

 

2017 Medicare Health Outcomes Survey-Modified (HOS-M) Electronic Data – Dated 7/20/2018

Summary: The 2017 Medicare Health Outcomes Survey-Modified (HOS-M) beneficiary level data is available to the PACE plans who participated in the program.  The plans may retrieve their data by contacting the HOS Information and Technical Support listed in the memo.

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

 

Validate Opioid Point of Sale Claim Edit Information in the Medicare Advantage and Prescription Drug System – Dated 7/20/2018

Summary: CMS request plans to review and update current opioid point of sale beneficiary specific claim edit information in MARx by August 31, 2018 for preparation of the new drug management programs taking effect in 2019.  Within the July 2018 Detail OMS report package, an additional file will be made available to plans with a list of beneficiaries with current opioid POS edit information from MARx. If a plan does not receive the file, no further action is needed as no beneficiaries with active opioid POS edits are currently in place. If a plan does receive the file, the plan is to review the data and verify that the information is correct.  If information requires updating, plan must do so within MARx.  

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

 

Documentation to Support Part D Exception Requests – Dated 7/24/2018

Summary: CMS remind plans of the processes explained in the Prescription Drug Benefit Manual Chapter 18 regarding exceptions which describes the rights and responsibilities of Part D enrollees, their providers and plans in requesting and processing exception requests.

Action: Informational to PACE.

 

Model Notice and Policy Updates – Dated 7/24/2018

Summary: CMS posted the CY 2019 model materials on the Marketing Models, Standard Documents, and Educational Material and Part D Model Materials websites.  The updated models are available at the link provided.  

Action: Informational to PACE.

 

8 Important Reports a PACE Organization Should Receive

 

Indication-Based Utilization Management – Dated 7/25/2018

Summary: CMS provided information to plans on employing indication-based utilization management in Part D through prior authorization requirements.  Instructions on how to update CY 2019 formulary files to reflect such program will be provided in a subsequent HPMS August formulary update.

Action: Informational to PACE plans that utilizes a formulary.

 

Release Date for Important 2019 Information – Dated 7/25/2018

Summary: CMS will release the Part D based beneficiary premium, the Part D national average monthly bid amount, the de minimis amount, and other important Part C and Part D information for CY 2019 on July 31st, 2018. 

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

 

Contract Year 2018 Provider and Pharmacy Directory Monitoring Frequently Asked Questions – Dated 7/26/2018

Summary: CMS released the CY 2018 Provider and Pharmacy Directory Monitoring Frequently Asked Questions document.  It has been updated based on the webinar and questions submitted.  

Action: Informational to PACE.

 

Summer Limited Update Window for CY 2019 Formulary Submissions – Dated 7/26/2018

Summary: CMS is granting conditional approvals for CY 2019 formularies and is in the process of contacting organizations that have outstanding formulary issues to schedule a negotiation call.  Organizations with a small number of formulary issues will receive the first negotiation calls and will more likely be eligible for the summer update window on August 6, 2018 through August 8, 2018.

Action: Informational to PACE plans that utilizes a formulary.

 

Medicare Part C Reporting Requirements – Comment Period – Dated 7/26/2018

Summary: CMS announced the opportunity for plans to comment on the proposed 2019 Part C Requirements document.  The draft is a revision to a previously approved collection.  Comments can be submitted by August 13, 2018.  The link to the proposed document and instructions for submitting comments is provided.  

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

 

Important Date Reminders

Date

      Item

11:59 PM PT on July 31, 2018

2017 Direct & Indirect Remuneration (DIR) Submission Deadline

11:59 PM PT on July 31, 2018

2013, 2014, 2015, and 2016 DIR Resubmission Deadline

(If any changes or errors to the DIR amount)

Mid-August-

Mid-September 2018*

2017 Attestations of PDE, DIR Data, P2P Reconciliation Payments and Detailed DIR Report Submission Period

January 1, 2019

Preclusion List Requirement Begins

*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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