Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Release Date for Important 2018 Information
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Learn more about CMS Updates that may impact your PACE Plan.

Release of the Health Plan Management System (HPMS) module for use by State Pharmaceutical Assistance Programs and AIDS Drug Assistance Programs – Dated 7/14/2017

Summary: CMS announced the release of the new Health Plan Management System (HPMS) Module for State Pharmaceutical Assistance Programs (SPAPs) and AIDS Drug Assistance Programs (ADAPs).  The HPMS module will provide a secure point of contact for SPAPs and ADAPs when communicating with CMS for CY 2018.

Action: Informational to PACE as this only applies to SPAPs and ADAPs.

 

Part D Summary 2016 DIR Report and Detailed 2016 DIR Report –Submission Reminder – Dated 7/18/2017

Summary: CMS reminds plans of the deadline to submit Summary 2016 DIR Report and Detailed 2016 DIR Report by July 31, 2017 at 11:59 PM PT.  Failure to successfully submit the DIR data by the deadline may result in compliance actions. 

Action: Applicable to PACE.  Refer to the memo for complete details on the DIR submission requirements.  Pharmastar will provide the DIR reports and notify your plan once they are available.  Please contact your Client Support Specialist if you have any questions.

 

Part D Summary 2012 DIR Report for the 2012 Reopening – Submission Reminder – Dated 7/18/2017

Summary: CMS reminds plans of the deadline to submit Summary 2012 DIR Report for the 2012 reopening by July 31, 2017 at 11:59 PM PT. If a plan does not need to resubmit a report, they can disregard this reminder.

Action: Applicable to PACE plans that need to resubmit a Summary 2012 DIR Report for the reopening.  Pharmastar will provide the DIR reports and notify your plan once they are available.  Please contact your Client Support Specialist if you have any questions.

 

Medicare-Medicaid Plan Updated Provider and Pharmacy Directory Monitoring FAQ – Dated 7/18/2017

Summary: CMS provided an updated Medicare-Medicaid Plan Provider and Pharmacy Directory Monitoring FAQ document.  The document is available online on the CMS website.

Action: Informational to PACE.

 

Training Webinars Available on Self-Management Support, Disability Competent Care, and Meaningful Member Engagement – Dated 7/18/2017

Summary: CMS provided a listing of upcoming webinars from the CMS Medicare-Medicaid Coordination Office.  The webinars offer training to all health plans to improve the quality and delivery of care of their participants.  

Action: Informational to PACE.  Refer to the email for a list of the webinars and how to register.

 

Updates for CMS’ 2017 MA & PDP Fall Conference & Webcast Announcement – Dated 7/19/2017

Summary: CMS made changes to the in-person registration process for both conferences. The conference is held on September 7, 2017.

Action: Informational to PACE. Refer to the memo for complete details on the session topics and how to register.

 

CY 2018 Formulary Timelines and Processes – Dated 7/20/2017

Summary: CMS reminds all plans of the importance of resolving any outstanding formulary concerns. Plans whose formularies still have outstanding issues will be contacted by CMS to schedule a negotiation call.  Only plans that have received prior CMS conditional formulary approval will be permitted to submit an update during the summer update window.  Plans must resolve all outstanding issues and receive conditional approval for their CY 2018 formulary no later than September 1, 2017 to be eligible to offer Part D benefits during CY 2018.

Action: Applicable to PACE plans that utilizes a formulary. Refer to the memo for complete details.

 

Planned Updates to MMP Medicare A/B Rate Methodology for CY 2018 – Dated 7/20/2017

Summary: CMS released updates on the Medicare component of the Medicare-Medicaid Plans rates for CY 2018.

Action: Informational to PACE.

 

Contract Year 2018 Medicare Marketing Guidelines – Dated 7/20/2017

Summary: CMS announced the release of the 2018 Medicare Marketing Guidelines.  There have been several notable revisions.  The summary of changes to the 2018 Medicare Marketing Guidelines is provided.

Action: Informational to PACE as PACE does not follow the MAPD marketing guideline requirements.

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Re-Determination of Part D Low-Income Subsidy Eligibility for 2018 – Dated 7/24/2017

Summary: CMS provided organizations with information and guidance on re-determination of LIS eligibility and the responsibility of plans to conduct outreach to members who no longer automatically qualify for LIS in 2018.

Action: Informational to PACE.  Refer to the memo for guidance and plan responsibilities.

 

Release Date for Important 2018 Information – Dated 7/25/2017

Summary: CMS released the Part D base beneficiary premium, the Part D national average monthly bid amount, the de minimis amount, and other important Part C and D information for contract year 2018.

Action: Informational to PACE.

 

Request for Comments on Updates to the CY 2018 Core Reporting Requirements for Medicare-Medicaid Plans – Dated 7/26/2017

Summary: CMS requested for feedback and comments on the draft Calendar Year 2018 Medicare-Medicaid Capitated Financial Alignment Model Core Reporting Requirements.

Action: Informational to PACE as PACE is not a Medicare-Medicaid Capitated Financial Alignment model.

 

Model Notice Corrections/Policy Updates – Dated 7/27/2017

Summary: CMS released updates to clarify and correct the standardized language that Medicare Advantage Organizations and Part D Sponsors must use in the CY 2017 Annual Notice of Change/Evidence of Coverage and Part D EOB. 

Action: Informational to PACE as PACE plans do not follow the MAPD marketing guidelines.

 

Important Date Reminders

Date

      Item

June 30 – July 31, 2017

11:59 PM PT

CY 2016 Direct and Indirect Remuneration (DIR) Submission Deadline

July 1 – July 31, 2017 11:59 PM PT

CY 2012-2015 Direct and Indirect Remuneration (DIR)

Re-submission Period (If any changes or errors)

Mid August-

Mid September 2017*

2016 Attestations of PDE, DIR Data, P2P Reconciliation Payments and Detailed DIR Report Submission Period

August 21 –

September 1, 2017

CY 2018 Formulary-Level Cumulative Opioid MED POS Edit Template Submission Period

April 2018

Medicare Diabetes Prevention Program services to be covered for eligible Medicare beneficiaries.

April 2018

New Medicare Card (Formerly known as SSNRI) to Begin

January 2019

Enforcement Date for the Prescriber Enrollment Requirement

 

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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