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

Designation of Enterprise Identity Management (EIDM) Plan User Approver/External Point of Contact (EPOC) – ACTION – Dated 10/5/2018

Summary: CMS released the requirements and process a plan must use to designate staff that will be responsible for granting access to their data in the CMS systems as well as the responsibilities of a CMS External Point of Contact (EPOC).

Action: Applicable to PACE.  Refer to the memo for complete instructions on the EPOC registration process and annual certification requirements which are due by December 1st of each year.  Contact MAPD Helpdesk with any questions.

 

2019 Star Ratings Marketing Template – Dated 10/5/2018

Summary: CMS released the 2019 Star Ratings Template which will be available in HPMS on October 10, 2018 along with the release of the 2019 Star Ratings on The Medicare Plan Finder.  Plans are required to use the updated 2018 Star Ratings in all marketing materials that reference the 2018 benefit within 21 days of the public release of the information.

Action: Informational to PACE as PACE does not participate in the Star Ratings.

 

 Upcoming Complaints Tracking Module Updates – Dated 10/9/2018

Summary: CMS will provide an update to the Complaints Tracking Module (CTM) which will affect all plan users.  The updates include:

  • A new field on the resolution screen called “Resolution Notification?”
  • Changes made to the Plan Casework Upload File Record Layout and the Plan Download File Record Layout to reflect the new Resolution Notification field.

Action: Informational to PACE.  PACE organizations are expected to monitor CTM.

 

Draft 2020 Application Cycle Past Performance Review Methodology – Dated 10/9/2018

Summary: CMS published the draft 2020 Past Performance Assessment Review methodology and is seeking comments which will be considered when the final version is published.  Comments can be submitted by November 9, 2018.

Action: Informational to PACE as PACE plans remain excluded from the past performance assessment analysis.

 

Reminder: Payment Years 2016 and 2017 Risk Adjustment Attestations – Dated 10/9/2018

Summary: CMS remind plans of the deadline for submitting the required risk adjustment attestation for payment years 2016 and 2017 on October 15th.  Plans are to complete the attestation applicable to their plan contract and submit to CMS via the pathlink provided.

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

 

Correction: Upcoming Complaints Tracking Module Updates – Dated 10/10/2018

Summary: CMS provided an update to the field description column on page 6 of the memo from “Medicare Billing Identifier” to “Medicare Beneficiary Identifier”.

Action: Informational to PACE.

 

2017 Final Part D Payment Reconciliation – Dated 10/10/2018

Summary: CMS completed the calculations for the 2017 Final Part D Payment Reconciliation.  The payment reconciliation reports will be available in the reconciliation mailboxes at CSSC on October 11, 2018.  Payment adjustments to remit and recover these calculation reconciliation amounts are planned for November 2018 payment.

Action: Applicable to PACE.  Refer to the memo for complete details.  If you cannot access these reports, please contact CSSC.

 

Marketing Guidelines Link Correction and Updated Star Ratings Marketing Template – Dated 10/12/2018

Summary: CMS provided an updated link to the Marketing guidelines that was announced in the 2019 Star Ratings Marketing Template.  In addition, plans may need to redownload their contract’s templates to ensure the correct Customer Service Call Center Hours of Operation are listed.

Action: Informational to PACE.

 

Update to the HPMS Memo “2019 Reporting Requirements for HEDIS, HOS and CAHPS Quality Measures” – Dated 10/12/2018

Summary: CMS provided updates to one measure listed in the CMS memo, “Reporting Requirements for 2018 HEDIS, HOS and CAHPS Measures” that was affected by the NCQA October Update.

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

 

CMS Mailing to Enrollees in Consistently Low Performing Plans – Dated 10/16/2018

Summary: CMS will begin mailing beneficiaries in late-October a notice to alert them of their sponsor or organization’s low ratings to encourage the beneficiary to review higher rated plan options during the annual election period.  The notice informs enrollees of an opportunity to move into a higher quality plan in 2019.

Action: Informational to PACE.

 

Release of Notice of Intent to Apply for Contract Year 2020 Medicare Advantage, Medicare-Medicaid Plans, and Prescription Drug Benefit and Related CY 2020 Application Deadlines – Dated 10/15/2018

Summary: CMS announced the release of the CY 2020 Notice of Intent to Apply (NOIA) web tool and key dates for the CY 2020 Medicare Advantage (Part C) and Prescription Drug Benefit (Part D) application cycle.  The memo details the CY 2020 application cycle key dates.

Action: Informational to PACE as PACE plans have their own application process.

 

Encounter Data Software Release – Chart Review Record Edits – Dated 10/15/2018

Summary: CMS provided information on system changes related to chart review records resulting from a recent CMS analysis.  The changes will be implemented on October 26, 2018 in the Encounter Data Processing System.

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

 

Release of Payment Condition Count Model Software and ICD-9 Diagnosis to HCC Mappings – Dated 10/16/2018

Summary: Based on feedback received on the Part I 2019 Advance Notice about the new PCC Model, CMS has delayed the implementation of the new PCC model.  Additional information about the new PCC model, is available on the Risk Adjustment page of the CMS website.  A conference call to discuss the PCC models presented in the 2019 Advance Notice will be held on October 24, 2018 from 2PM to 3PM EDT.

Action: Informational to PACE.  For PACE plans interested in participating and learning more about the PCC models, refer to the memo for complete details on how to join the conference call.

 

Proposed Updates to Encounter Data Report Cards – For Comment – Dated 10/17/2018

Summary: CMS proposed a re-designed encounter data report card and is seeking input from stakeholders.  There are four major changes to the contact and format of the report cards.  Any feedback and comments can be submitted by November 19, 2018 to the email provided.

Action: Informational to PACE.  Refer to the memo for complete details on the changes to the encounter data report card.

 

Retail Pharmacy Network Access and Preferred Cost-Sharing Pharmacy Access Analysis Results for Q3 CY 2018 – Dated 10/17/2018

Summary: CMS released the retail pharmacy access analysis for Q3 for 2018.  Plans can review the data and submit questions and/or concerns to CMS prior to CMS publishing the data to the CMS webpage.

Action: Informational to PACE.

 

Posting of 2019 Stand-alone PDP Total Beneficiary Cost (TBC) Data on www.cms.gov – Dated 10/17/2018

Summary: CMS released the CY 2019 stand-alone PDP Total Beneficiary Cost data and methodology on the CMS website.  A link to the methodology and data is provided.

Action: Informational to PACE.

 

Part D Coordination of Benefits Process Updates – Dated 10/18/2018

Summary: CMS announced two forthcoming updates to the CMS Part D Coordination of Benefits process.  The updates pertain to the Financial Information Reporting (FIR) transactions which are part of the Automated TrOOP Balance Transfers and will impact how FIR transactions are processed for certain retroactive terminations beginning on January 1, 2019.  

Action: Applicable to PACE.  Refer to the memo for complete details.  Pharmastar can review and assist with FIR rejections that may occur.

 

Important Date Reminders

Date

      Item

December 14, 2018

Complete and submit the Annual Full File Replace ATBT and NX Report Distribution Email List for 2016-2019

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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