Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Updated 2017 Star Ratings Data
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Learn more about CMS Updates that may impact your PACE Plan.

Training for 2016 Quality Improvement Project Plan Section Submissions –Dated 9/23/2016

Summary: CMS released information on the upcoming training for the 2016 Quality Improvement Project (QIP) Plan Section submissions.  All Medicare Advantage Organizations must conduct a QIP as part of the Medicare Advantage Quality Improvement Program regulations.  The QIP training will be on October 5, 2016.  The QIP training follow up Q&A session will be on October 26, 2016.

Action: Informational to PACE as the requirement does not apply to PACE plans.

 

2017 Reassignment of Low-Income Subsidy Beneficiaries in Non-Renewing Medicare Advantage Plans and Medicare Advantage Plans Reducing their Service Areas –Dated 9/23/2016

Summary: CMS will conduct reassignments of beneficiaries eligible for the Part D low-income subside who are enrolled in certain Medicare Advantage plans.  The reassignment occurs for MA plans that are non-renewing or have an approved SAR as of 2017.  CMS will process reassignment transactions and transmit a special TRR to plans on or around October 10, 2016.

Action: Informational to PACE.  Refer to the memo for additional information and detail on the process.

Read the Pharmastar Blog

 

Medicare Advantage/Prescription Drug System (MARx) October 2016 Payment – INFORMATION –Dated 9/27/2016

Summary: CMS released information on the October payment which is schedule for October 1, 2016 and may require plan action:

  • Coverage Gap Discount (CGD) Invoice Offsets for 2015 and 2016
  • January 2016 Payment Clean-up

Action: Informational to PACE.  Refer to the memo for items that may be applicable to your plan.

CORRECTION- Announcement of Encounter Data System (EDPS) Technical Release Memo –Dated 9/27/2016

Summary: CMS made a correction to the software release memo released on July 8, 2016 to correct the descriptor for Encounter Data Processing System edit 98300.  The edit provided in July memo was incorrect and should read “Exact Inpatient Duplicate Encounter”.

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

 

Updated 2017 Star Ratings Data –Dated 9/28/2016

Summary: CMS informed plans that they can view their updated 2017 Star Ratings data in HPMS.  To access the Star Ratings data, follow the path provided.

Action: Informational to PACE.

 

Coverage Gap Discount Program: October Participating Labeler Code Update –Dated 9/28/2016

Summary: CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program by October 1, 2016.  The updates include:

Added:

  • 70347 Aralez Pharmaceuticals US Inc.

Action: Although the Coverage Gap Discount Program does not apply to PACE, the participating labeler codes are applicable because only brand name prescriptions with NDCs from these codes are accepted for Part D payment.  Pharmastar has made the necessary software adjustments to accommodate for the updated codes.

 

2016 Call Center Monitoring Performance Metrics for Timeliness Study, Quarter 3 –Dated 9/29/2016

Summary: CMS released the elements and studies on the Part C and Part D call center monitoring for 2016 Quarter 3.

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

 

End-of-Year 2016 Enrollment and Payment Systems Processing Information –Dated 9/29/2016

Summary: CMS provided information to support plans in their end-of-year enrollment and payment systems processing activities to ensure a successful transition to CY 2017 regarding:

  1. Medicare Advantage & Prescription Drug (MARx) System Transaction Processing;
  2. Rollover and Terminating Plan MARx Transaction Processing; and
  3. Plan Reports and System User Interface (UI) Availability. 

Action: Applicable to PACE.  Refer to the memo for additional details and items applicable to your plan.

 

General Announcement of the Social Security Removal Number Initiative (SSNRI) –Dated 9/29/2016

Summary: CMS will remove the Social Security Numbers (SSNs) from all Medicare cards by April 2019.  A Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions.  The MBI number will be 11 characters in length and made up of numbers and uppercase letters. CMS will start sending new Medicare cards with the MBI to all Medicare beneficiaries no earlier than April 2018.

Action: Informational to PACE.

 

Participation in 2017 HOS for MA Organizations Planning to Sponsor FIDE SNPs in 2018 –Dated 9/29/2016

Summary: CMS released information to MA organizations that anticipates sponsoring a FIDE SNP in 2018 and that wants to participate in the 2017 HOS or HOS-M.  For interested MA organizations, the list of information requested must be provided to CMS by October 31, 2016.

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

 

September 2016 Release Pharmacy Risk Assessment-Feedback Requested –Dated 9/30/2016

Summary: The Risk Assessment for September 2016 has been completed by CMS in collaboration with National Benefit Integrity Medicare Drug Integrity Contactor.  CMS provided a list of retail pharmacies categorized with a high risk assessment and expects plans to use the information provided to make further determinations about potential fraud, waste and abuse to the pharmacies that have been identified for your plan.  CMS expects plans to take the actions mentioned in the memo.  Any feedback on action taken on pharmacies in your network even if they are not included in the attached list can be sent to CMS within 30 days of receipt of this memo. 

Action: Applicable to PACE plans.  Refer to the memo for additional details; as plans are required to adopt and implement an effective compliance program which includes measures designed to prevent, detect and correct FWA.

Pharmastar will review the list of pharmacies and reach out to plans if a pharmacy they utilize for their participants has been identified as high risk assessment.

 

Posting of 2017 Plan Benefit Data and Plan Crosswalk Data on www.cms.gov –Dated 10/3/2016

Summary: CMS released the 2017 approved plan benefit data and plan crosswalk data on the CMS website.  The URL for the cross walk and benefit data files are provided.

Action: Informational to PACE.  Refer to email for additional details.

 

Imaging Dementia –Evidence for Amyloid Scanning (IDEAS) Clinical Trial Coverage Clarification –Dated 10/3/2016

Summary: CMS reminds Medicare Advantage Organizations (MAOs) of their responsibility to cover national coverage determinations approved under coverage of evidence.  CMS has learned that some MAOs are denying claims for IDEAS as they do not believe they are responsible for covering the trial. MAOs must cover IDEAS if a patient is enrolled in a Medicare-approved clinical study and meet the criterias.

Action: Informational to PACE.  Refer to the email for additional information on the clinical trial.

 

Medicare-Medicaid Plan Provider and Pharmacy Directory Monitoring FAQ –Dated 10/3/2016

Summary: CMS will provide the Medicare-Medicaid Plan (MMP) Provider and Pharmacy Directory Monitoring FAQ document to the CMS website.  This FAQ is in response to questions asked during the technical assistance webinar which was held on September 7, 2016.  CMS will being monitoring CY 2017 MMP Directories in the fall of 2016.

Action: Informational to PACE.

 

Opportunities for MMPs, PACE organizations, and D-SNPs to Prevent Identify, and Treat Opioid Addiction or Misuse among Medicare-Medicaid Dually Eligible Beneficiaries –Dated 10/3/2016

Summary: CMS reminds plans of the opportunities they have to prevent, identify, and comprehensively treat opioid addition or misuse among dually eligible enrollees.  Plans should develop and implement comprehensive pain management strategies to mitigate or prevent opioid misuse without the side effects associated with opioid therapies.  CMS provided key opportunities to assist plans on what they can do.

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

 

2016 Quality Improvement Project (QIP) Plan Section Training Reminder –Dated 10/4/2016

Summary: CMS reminds Medicare Advantage Organizations and Medicare-Medicaid Plans that the 2016 Quality Improvement Project Plan Section training will be held on October 5th

Action: Informational to PACE. To join the session, refer to the email for additional information.

 

Preparation for 2017 Contract Year Coordination of Benefits Activities –Dated 10/5/2016

Summary: CMS encourages plans to prepare for the Part D Coordination of Benefits (COB) requirements for CY 2017 by doing the following:

  • Complete a new distribution form with RelayHealth for the Part D Sponsor Performance Reports related to Supplemental Information Requests (Nx) and Financial Information Reporting (FIR) no later than December 16, 2016.
  • If there is not one already on file, complete a BAA with RelayHealth no later than December 16, 2016.  

Action: Applicable to PACE.  Refer to the memo for complete details.  Any existing emails will NOT roll over into the new plan year. Plans that do not complete and submit the distribution form will no longer receive reports as of January 2, 2017. Contact your Client Support Specialist if you have any questions.  

 

2017 Readiness Checklist for Medicare Advantage Organizations, Prescription Drug Plans, and Cost Plans –Dated 10/5/2016

Summary: The Contract Year (CY) 2017 Readiness Checklist from CMS summarizes key operational requirements for organizations to review and perform their own internal audits for 2017 preparedness and eventual reporting purposes.

Action: Applicable to PACE.  Refer to the memo for additional details and items applicable to your plan.  Any questions should be addressed to the appropriate individual(s) listed on attachment Appendix A.  Pharmastar will review and provide a list of the sections we will take responsibility for and provide supporting policy and procedures to how they will be handled.

 

Announcement of New Emergency Preparedness Requirements for PACE Organizations –Dated 10/6/2016

Summary: CMS posted the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule in the Federal Register on September 8, 2016.  All PACE organizations must comply with the new requirements by November 16, 2017.

Action: Applicable to PACE. Refer to the email for additional information by visiting the CMS website provided.

 

HPMS Marketing Module Enhanced Functionality –Dated 10/6/2016

Summary: CMS added an improved function in the HPMS Marketing Module to allow plans to add newly approved contracts to their existing materials.   

Action: Informational to PACE as the functionality does not apply to PACE specific codes.

 

Availability of 2017 Medicare Star Ratings Marketing Template –Dated 10/6/2016

Summary: CMS will provide the 2017 Medicare Star Ratings Template in HPMS on October 12, 2016 for Medicare Advantage Organizations and Part D plans to include with all enrollment forms and make available on their websites. 

Action: Informational to PACE.

 

RESEND - 2017 Readiness Checklist for Medicare Advantage Organizations, Prescription Drug Plans, and Cost Plans –Dated 10/6/2016

Summary: CMS resent the Contract Year (CY) 2017 Readiness Checklist to include the word version of the readiness checklist document.

Action: Applicable to PACE.  Refer to the memo for additional details and items applicable to your plan.  Any questions should be addressed to the appropriate individual(s) listed on attachment Appendix A.  Pharmastar will review and provide a list of the sections we will take responsibility for and provide supporting policy and procedures to how they will be handled.

 

 

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