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

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.


Contract Year 2017 Monitoring of Medicare-Medicaid Plan Provider and Pharmacy Directories –Dated 11/4/2016

Summary: CMS released upcoming monitoring information of Contract Year 2017 Provider and Pharmacy Directories.  The Medicare-Medicaid Coordination Office, through a contractor, will review a sample of the MMP CY 2017 print and online Provider and Pharmacy Directories during November 18 – January 20, 2017.  

Action: Informational to PACE.


2018 Quality Bonus Payment Determinations and Administrative Review Process for Quality Bonus Payments and Rebate Retention Allowances –Dated 11/4/2016

Summary: CMS released information on the quality bonus payments to Medicare Advantage organizations that achieve at least 4 stars in a 5-star quality rating system.

Action: Informational to PACE as PACE does not follow the MAPD marketing guidelines and does not participate in payment adjustments linked to MA plan Star ratings.


Part D Model Material Notices for MMPs for Contract Year 2017 –Dated 11/7/2016

Summary: CMS instructed MMPs to delay the use of the Part D Provisional Supply Letter and the combination Part D Provisional Supply/Transition Letter until further notice due to the revised implementation date of the Part D Prescriber Enrollment Requirement.

Action: Informational to PACE.


Contract Year 2017 Essential Hospital Designation and Attestation –Dated 11/8/2016

Summary: CMS advised Medicare Advantage Regional Preferred Provider Organizations (RPPOs) that they must request CMS approval to designate essential hospitals.  RPPOs requesting hospital designation for one or more non-contracted hospitals must submit the following items mentioned in the memo to CMS by November 30, 2016.

Action: Informational to PACE as PACE is not a Medicare Advantage Regional Preferred Provider Organization.


Medicare Parts C and D Program Audit Protocols and Data Requests – 30 day comment period – Dated 11/8/2016

Summary: CMS announced the release of the 30 day comment period for the Medicare Parts C and D Program Audit Protocols.  The comment period closes on December 5, 2016.

Action: Informational to PACE as PACE plans have their own audit protocols. However, PACE plans should be aware of the content in the Medicare Parts C and D Program Audit Protocols as it may be beneficial to your plan.


Advance Announcement of the February 2017 Software Release –Dated 11/9/2016

Summary: CMS released detailed information regarding the planned release of system changes scheduled for February 2017.  The changes are as follow to improve the efficiency of CMS systems as well as plan processing:

  • Seamless Conversion Enrollment Election Type
  • Medicare Secondary Payer Notification Enhancements
  • Medicaid Reporting Enhancements
  • Employer Group Waiver Plan Edit Removal and Flag Changes
  • Supplemental Data on the MAO-004 Report Due to Quarterly HCPCS/CPT Update
  • Risk Adjustment Suit of Systems MOR Maintenance for 2017
  • Update to the November 2016 Software Release Letter Regarding the New 2017 Part C Risk Adjustment Model

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


Social Security Number Removal Initiative (SSNRI) Selected Updates for Medicare Advantage and Part D Plans –Dated 11/9/2016

Summary: CMS released general information on the implementation of the Social Security Number Removal Initiative which requires Social Security Numbers to be removed from all Medicare cards by April 2019.  The information is to assist plans in preparing for the transition.  Additional details on the process and system changes will be communicated in future CMS memos.

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

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2017 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) –Dated 11/10/2016

Summary: CMS released the guidance on the updated resource limits for individuals who apply and qualify for the low-income subsidy (LIS) and the maximum co-payments for LIS beneficiaries.  The methods CMS used to update the resource limits and the cost-sharing amounts for 2017 are attached.

Action: Informational to PACE.


Request for Comments: Enhancements to the Star Ratings for 2018 and Beyond –Dated 11/10/2016

Summary: CMS is requesting for comments related to the 2018 Star Ratings for the draft 2018 Call Letter.  Comments can be submitted by November 29th at 5pm ET and sent to the email provided in the memo.

Action: Informational to PACE. 


Draft Medication Therapy Management Improvements – Standardized Format 60-day Comment Period –Dated 11/14/2016

Summary: CMS is requesting for comments to the proposed Medication Therapy Management Improvements – Standardized Format. Comments can be submitted by December 30, 2016.  

Action: Informational to PACE as PACE is waived of the MTM program requirements.


Update on Part D Payment Responsibility for Drugs for Beneficiaries Enrolled in Medicare Hospice –Dated 11/15/2016

Summary: CMS released a summary of recent analysis of Part D claims data for beneficiaries enrolled in hospice and reminds plans of the guidance related to Part D payments for drugs for beneficiaries enrolled in the Medicare hospice benefit.

Action: Informational to PACE as PACE participants cannot be enrolled in PACE and in Hospice at the same time.


Reporting of National and Medicare Advantage Contract-Level Quality Scores by Race and Ethnicity –Dated 11/15/2016

Summary: CMS has released MA data detailing the health care experiences and quality of care received by Medicare beneficiaries by racial and ethnic group.  The reports will be available annually on the CMS Office of Minority Health website.  Plans can use the information for health and drug plan quality improvement and accountability purposes.  

Action: Informational to PACE.  


SNP MOC Public Reporting –Dated 11/16/2016

Summary: CMS is notifying Special Needs Plans that the CY 2017 Model of Care Public Reports is available on the SNP MOC website.

Action: Informational to PACE.


SNP and MMP Off-Cycle MOC Revision Submissions Training Auto forwarded by a Rule –Dated 11/16/2016

Summary: CMS released information to Special Needs Plans and Medicare-Medicaid Plans on a training session to discuss Off-cycle Submission of Model of Care revisions.  The training will be held on November 30, 2016.

Action: Informational to PACE. Refer to email for complete training session information.


2017 Part C and Part D Call Center Monitoring and Guidance for Timeliness and Accuracy and Accessibility Studies –Dated 11/16/2016

Summary: CMS announced they will continue to monitor Part C and Part D call centers in 2017.  The memo includes the elements CMS will monitor and explains how to prepare for the monitoring studies.  Additionally, plans should update their 2017 call center information in HPMS no later than January 2, 2017.

Action: Informational to PACE.


2017 Medicare CAHPS Survey –Dated 11/16/2016

Summary: CMS reminds plans about the 2017 Medicare CAHPS Survey, the procedures for requesting additional sample, and the rules regarding the number of supplemental items.  In addition, information on the delivery of the reports on the results to contracts.

Action: Informational to PACE as PACE is waived of the CAHPS survey requirement.


Notice of the 30-day comment period for the Information Collection Request (ICR) for the Part C and Part D Data Validation for 2017-2018 –Dated 11/17/2016

Summary: CMS announced the opportunity for plans to comment on the proposed ICR for the Medicare Part C and Part D Data Validation for Reporting Requirements data for the 2017 and 2018 collection periods.  Comments can be submitted by December 5, 2016.

Action: Informational to PACE.  


Contract Year 2017 Medicare-Medicaid Plan Readiness Checklist –Dated 11/17/2016

Summary: CMS released the 2017 Readiness Checklist for MMPs.  The checklist is meant to serve as a technical assistance for Medicare requirements that should be in place for CY 2017.

Action: Informational to PACE as PACE plans should refer to the 2017 Readiness Checklist that was released on October 5, 2016.


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