Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Updates to the Part D Potential Exclusion Warning Report as of the First Quarter of 2018
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Learn more about CMS Updates that may impact your PACE Plan.

Posting of Quarterly 2018 Plan Benefit Data on www.cms.gov – Quarter 2 – Dated 1/3/2018

Summary: CMS released the Contract Year 2018 approved plan benefit data for Quarter 2.  The information is now available on the CMS public website.

Action: Informational to PACE.

 

Medical Supplies Associated with the Injection of Insulin – Dated 1/5/2018

Summary: CMS provided guidance regarding Part D coverage of the new types of insulin delivery devices.  If the new insulin delivery devices are not covered under the Medicare Part B DME benefit, then they can be billed under Part D as they meet the definition of a “Part D Covered Drug”.  Plans may choose to cover these devices and include it in their formularies.

Action: Applicable to PACE.  For any new insulin delivery devices authorized by the PACE participant’s IDT, it should be covered and billed to Part D if not covered under Part B.

 

Part D Late Enrollment Penalty Guidance and Model Notice Adjustments Due to Systems Changes for Premium Withholding – Dated 1/5/2018

Summary: CMS updated the Chapter 4 Medicare Prescription Drug Benefit Manual to address system and operational changes for how plans collect owed premiums in certain circumstances and provide clarification on the policy related to involuntary disenrollments due to non-payment premiums.  The updates will go into effect within 90 days of the date of this memorandum.

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

 

Updates to the Part D Potential Exclusion Warning Report as of the First Quarter of 2018 – Dated 1/10/2018

Summary: CMS announced updates that will be made to the first quarter of 2018 for Contract Year 2017 Part D Potential Exclusion Warning Report.  Plans should address the flagged PDEs in the warning reports within 90 days to remain compliant with CMS requirements.  Plans are to use their best judgement to determine if PDEs need to be adjusted or deleted.  A chart with the flagged PDE categories is provided to reflect the changes to the date of death editing.

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

 

2014 Benefit Year Closeout for the Coverage Gap Discount Program Invoicing Cycle – Dated 1/10/2018

Summary: CMS reminds plans of the upcoming closeout of the benefit year 2014 Coverage Gap Discount Program invoicing cycle.  Any PDE records reporting gap discount amounts for benefit year 2014 requiring submission, adjustments or deletions for any reason must be submitted by January 31, 2018 to be invoiced for manufacturer payment.

Action: Informational to PACE as PACE is not eligible to participate in the Coverage Gap Discount Program.

 

PDE Processing Error Related to NSDE File and Edit 867 – Dated 1/10/2018

Summary: CMS became aware of an issue with the NSDE file that is causing PDE rejection code of 867.  The issue has been resolved and any affected PDEs can be resubmitted.

Action: Informational to PACE as the PDE rejection code is related to Coverage Gap Discount and edit is not applicable to PACE.

 

Contract Year 2018 Changes to Network Review Process for Medicare Advantage Organizations and Section 1876 Cost Plans – Dated 1/10/2018

Summary: CMS announced changes to the network review process for MA organizations and Section 1876 cost plans for Contract Year 2018.  CMS will now review organizations’ networks on a three year cycle unless triggered events resets the timing of the organizations’ triennial review.

Action: Informational to PACE.  

 

DISCLAIMER REMOVED: Part D Late Enrollment Penalty Guidance and Model Notice Adjustments Due to Systems Changes for Premium Withholding – Dated 1/10/2018

Summary: CMS removed the disclaimer note on the memo.  The memo discussed updates to the Chapter 4 Medicare Prescription Drug Benefit Manual to address system and operational changes for how plans collect owed premiums in certain circumstances and provide clarification on the policy related to involuntary disenrollments due to non-payment premiums.  The updates will go into effect within 90 days of the date of this memorandum.

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

 

Released of Contract Year 2019 Medicare Advantage (MA), Medicare -Medicaid Plan (MMP), and Prescription Drug Benefit (Part D) and Related CY 2019 Application Deadlines – Dated 1/10/2018

Summary: CMS released the Contract Year 2019 MA, MMP, Part D and other related applications.  All applications are due to CMS by February 14, 2018. 

Action: Informational to PACE as PACE plans are not required to renew their contracts on a year to year basis as MA plans are required to and utilizes its own application and service area expansion process.

 

Reopening of the 2012 Final Part D Payment Reconciliation – Dated 1/11/2018

Summary: CMS completed the calculations for the reopening of the 2012 Final Part D Payment Reconciliation.  The payment reconciliation reports and Part D Exclusion from Reconciliation Reports for the 2012 reopening will be available on Tuesday, January 16, 2018 in the plan’s reconciliation mailboxes at the CSSC.

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

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