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

Contract Year 2018 Medicare-Medicaid Plan Summary of Marketing Practices and Beneficiary Disclosure Requirements – Dated 11/7/2017

Summary: CMS provided Medicare-Medicaid Plans who are participating in capitated model demonstrations under the Financial Alignment Initiative a summary of the similarity and differences in Contract Year (CY) 2018 marketing and beneficiary disclosure requirements.

Action: Informational to PACE.


Coverage of Part A and Part B Services: Medicare Diabetes Prevention Program Expanded Model – Dated 11/7/2017

Summary: CMS reminds plans of the Medicare Diabetes Prevention Program (MDPP) expanded model which goes into effect April 1, 2018.

Action: Applicable to PACE. Refer to the memo for complete details.  A link is provided for additional information on the MDPP.


Contract Year 2017 Part D Formulary Administration Analysis (FAA) – Dated 11/7/2017

Summary: CMS announced the performance of the formulary administration analysis (FAA) for CY 2017. The program will evaluate whether Part D Sponsors are appropriately adjudicating Part D drug claims consistent with Part D requirements and plans’ CMS approved benefits.  Plans selected for participation in the analysis will be notified and provided additional information.

Action: Applicable to PACE plans that submit a Part D Formulary via HPMS.  Refer to the memo for complete details.


Continued Obligations under the Federal Disaster or Other Public Health Emergency Declaration – Dated 11/14/2017

Summary: CMS reminds plans of their continued obligations and responsibilities on the beginning and end of disasters or public health emergencies as well as the status of the Secretary’s public health emergency declarations under section 1135 of the Social Security Act.

Action: Applicable to PACE.  PACE plans should reference the sources provided in the memo to monitor when a public health emergency declaration has ended and normal operations may resume.

Lack of Transparency: Combat Deceptive PBM Practices

Programs of All-Inclusive Care for the Elderly (PACE) Quality Measures Initiative – Dated 11/13/2017

Summary: CMS is looking for public comments on the three draft quality measures for PACE programs.  The project title for the measures is “Development, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) – Stream3”.  The comment period opens on November 15, 2017 and will close at December 15, 2017 at midnight ET.

Action: Applicable to PACE.  Refer to the link provided to access the public comment page for additional information.


2018 Medicare CAHPS Survey – Dated 11/15/2017

Summary: CMS reminds plans of the 2018 Medicare CAHPS Survey and the procedures for requesting additional sample and rules regarding the number of supplemental items.  In addition, CMS provided information on administering the survey in other languages and timeline and process for receipt of the CMS survey results.

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


Contract Year 2018 Medicare Diabetes Prevention Program Update for Medicare-Medicaid Plans – Dated 11/16/2017

Summary: CMS reminds Medicare-Medicaid Plans (MMP) to notify enrollees of the Medicare Diabetes Prevention Program at least 30 days before the April 1, 2018 effective date by making changes to the Member Handbook Chapter 4 and updating the CY 2018 Member Handbook posted on its website to include information on the Medicare Diabetes Prevention Program.

Action: Informational to PACE. Refer to the email for complete details as PACE is not excluded from the Medicare Diabetes Prevention Program.


2018 Resource and Cost-Sharing Limits for Low-Income Subside (LIS) – Dated 11/16/2017

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 2018 are attached.

Action: Informational to PACE.


Thanksgiving Holiday

The Pharmastar Administrative Office will be closed on November 23rd 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.

Important Date Reminders



December 15, 2017

Annual ATBT and Nx Report Distribution Email List for 2015-2018 are to be completed and submitted to RelayHealth to be effective for 2018.

January 2018

Sensipar- ESRD Treatment must be included in the ESRD PPS & no longer payable under Part D benefit.

April 2018

Medicare Diabetes Prevention Program services to be covered for eligible Medicare beneficiaries.

April 2018

New Medicare Card (Formerly known as SSNRI) to Begin

January 2019

Enforcement Date for the Prescriber Enrollment Requirement

*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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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.