Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Phased Implementation of the Medicare Part D Prescriber Enrollment Requirement by January 1, 2019
Not rendering correctly? View this email as a web page here.

Pharmastar_CMS_Header.jpg

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

 

Seamless Enrollment of Individuals upon Initial Eligibility for Medicare –Dated 10/21/2016

Summary: CMS announced a temporarily suspension of its acceptance of new seamless enrollment proposals. Medicare Advantage (MA) organizations listed in the reference posting are the only organizations currently approved to conduct seamless conversion enrollments.  Contact your CMS Account Manager no later than November 14, 2016 if you believe there is a discrepancy with the approved information.  For MA organizations currently approved to offer seamless conversion enrollments, CMS will release a memo soon to clarify current policy and requirements.  

Action: Informational to PACE.

 

PACE Replacement Center Transition Plan Guidance –Dated 10/21/2016

Summary: CMS released the guidance to PACE organizations regarding planned replacement of existing PACE centers.  PACE organizations contemplating replacement of existing PACE centers should discuss their plans as soon as possible with their CMS Account Manager.

Action: Applicable to PACE.  Refer to the memo for complete details if your PACE organization is planning to replace an existing PACE center.

 

Medicare Part D Overutilization Monitoring System (OMS) Update: Addition of the Concurrent Opioid-Benzodiazepine Use Flag –Dated 10/21/2016

Summary: CMS announced an update to the Overutilization Monitoring System (OMS) reports to add a concurrent benzodiazepine use flag to the report starting with the October 2016 cycle.  The reports are distributed quarterly to identify potential opioid overutilizers within a plan.  CMS expects plans to consider benzodiazepine use within their opioid overutilization review process.

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

 

Designation of Enterprise Identity Management (EIDM) Plan User Approver/External Point of Contact (EPOC) – ACTION –Dated 10/21/2016

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.  Contact MAPD Helpdesk with any questions.

 

Contractor Change for the Part D Prescription Drug Event Data Analysis Initiatives –Dated 10/21/2016

Summary: CMS announced the new contractor who will assist CMS with the Prescription Drug Event (PDE) Reports and PDE Analysis website initiatives. The reports and communications to plans on the PDE Reports and PDE Analysis website will remain the same and not change.  

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

 

Medicare Advantage/Prescription Drug System (MARx) November 2016 Payment –INFORMATION –Dated 10/24/2016

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

  • 2015 Final Part D Reconciliation
  • Part D Direct Subsidy Amounts/2015 Mid-Year Risk Adjustment Reconciliation Clean-up

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

 

Contract Year 2017 Monitoring of Marketed Comprehensive Formularies –Dated 10/24/2016

Summary: CMS will conduct a review comparing marketed formularies on plan websites for CY 2017 to their approved formularies that will be effective January 1, 2017.  CMS will select a random sample of Part D plans for inclusion in the analysis.  Part D plans that are selected for analysis will be notified and provided additional information. 

Action: Informational to PACE. For PACE plans who utilizes a formulary, refer to the memo for additional details.

 

CMS Mailing to Enrollees in Consistently Low Performing Plans –Dated 10/25/2016CMS

Summary: CMS will issue a notice to individuals enrolled in plans with less than three stars for three consecutive years to alert them to the plan’s low rating and encourage them to review higher rated plan options during the annual election period.  The notice also informs enrollees an opportunity to contact CMS to request for a special enrollment period to move into a higher quality plan in 2017.  The notice will be sent out in late-October

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

 

VBID: Year 2 (CY 2018) Request for Applications –Dated 10/25/2016

Summary: CMS released the Medicare Advantage Value-Based Insurance Design model test’s and request for organizations that wish to participate in the model test in 2018 to respond to the CY 2018 RFA by January 20, 2017

Action: Informational to PACE as PACE is not eligible to participant in the VBID model test.  

 

Contract Year 2016 QIP Plan Section Follow-Up Q&A Session –Dated 10/25/2016

Summary: CMS reminds Medicare Advantage Organizations and Medicare-Medicaid Plans that a follow up question and answer session regarding the Contract Year 2016 Quality Improvement Program Plan Section will be held on October 26, 2016.

Action: Informational to PACE.  

 

Medical Loss Ratio (MLR) Report and Attestation Submission Reminder for Contract Year 2015 –Dated 10/25/2016

Summary: CMS reminds plans that the upload functionality for CY 2015 MLR Reports will be available in HPMS from November 4, 2016 to December 2, 2016. The electronic Attestation functionality for CY 2015 MLR will be available December 5, 2016 to December 9, 2016.

Action: Informational to PACE as the MLR provision does not apply to PACE. 

 

Coverage Gap Discount Programs: November Participating Labeler Code Update –Dated 10/26/2016

Summary: CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program by November 1, 2016 to include:

70183 Lexicon Pharmaceuticals, 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.

 

Comprehensive Addiction and Recovery Act of 2016 (CARA) – Programs to Prevent Prescription Drug Abuse Under Medicare Parts C and D (Sec. 704) Stakeholder Meeting (MCS-4183-N) –Dated 10/27/2016

Summary: CMS shared the Federal Register announcement for a public meeting to solicit input from stakeholders regarding the section 704 of the Comprehensive Addiction and Recovery Act of 2016 which includes provisions to permit Part D plans to limit at-risk beneficiaries’ access to frequently abused drugs to certain prescribers and pharmacies.  The stakeholder meeting is held teleconference on November 14, 2016.

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

 

Plan Preview of Display Measures in HPMS –Dated 10/27/2016

Summary: CMS announced the availability of the display measures for Part C and D plans which can be previewed in HPMS prior to posting on the CMS from October 28- November 8.  Comments and questions on the display measures can be sent to CMS no later than November 8.

Action: Informational to PACE.

 

Contract Year 2017 Translated Materials Requirements and Methodology –Dated 10/28/2016

Summary: CMS has translated several Part C and D contract year (CY) 2017 model materials to alleviate some of the translation burden on sponsors and provide consistency among translated materials as required per the regulation implementation Section 1557 of the Affordable Care Act of 2010. 

Action: Informational to PACE.  Although the memo excludes PACE, PACE is still required to comply with Section 1557 and implementing regulation.  Refer to the CMS memo dated August 8, 2016 titled “Guidance regarding implementation of the procedural requirements under the regulation implementing Section 1557 of the Affordable Care Act of 2010 – Nondiscrimination Communication Requirements and Grievance Procedures” for additional information.

 

Solutions to Reduce Disparities: CMS Equity Plan for Medicare One Year Later –Dated 10/28/2016

Summary: CMS will host a webinar on November 14th, from 2-3pm ET to highlight new resources developed under the CMS Equity Plan for Medicare which include tools to help plans improve the quality of care for beneficiaries.

Action: Informational to PACE.  Refer to the email for complete details on the webinar and agenda topics.

Read the Pharmastar Blog

Coverage Gap Discount Program: November Participating Labeler Code Update –Dated 10/31/2016

Summary: CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program by November 1, 2016 to include:

70183 Lexicon Pharmaceuticals, Inc.

64011 Ther Rx Corp (Inadvertently Deleted on November File)

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.

 

Phased Implementation of the Medicare Part D Prescriber Enrollment Requirement by January 1, 2019 –Dated 11/1/2016

Summary: CMS revised the date for the full enforcement of the Part D Prescriber Enrollment Requirement to January 1, 2019.  CMS will implement a multifaceted phased approach and provide further guidance which will employ additional strategies to increase prescriber enrollment and identify and eliminate vulnerabilities to strengthen the Medicare Part D program.

Action: Applicable to PACE.  Plans should continue to work with their prescribers to enroll with CMS if they have not done so already.  

 

Thanksgiving Holiday

The Pharmastar Administrative Office will be closed on November 24th in celebration of the Thanksgiving holiday.  As always, the 24/7 Pharmastar help desk will remain open for your needs throughout the coming holiday at 888-298-7770.

 

 

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.


 
iStock_85328599_MEDIUM.jpg
Questions?
A real person always answers the phone at Pharmastar.
Sometimes the most important questions happen after normal business office hours. That’s why you can always talk to one of our pharmacy technicians 24/7/365 simply by calling us at (888) 298-7770.