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

2018 Call Center Monitoring Performance Metrics for Timeliness Study, Quarter 2 – Dated 10/23/2018

Summary: CMS released the elements and studies on the Part C and Part D call center monitoring for 2018 Quarter 2.

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

 

Retail Pharmacy Network Access and Preferred Cost-Sharing Pharmacy Access Analysis Results for Q3 CY 2018 – Dated 10/23/2018

Summary: CMS identified an error related to the CMS’ retail pharmacy access analysis for Quarter 3 CY 2018 and has addressed and made the correction.  The data is available on HPMS for review.

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

 

Additional Guidance on Contract Year 2019 Formulary-Level Opioid Point-of-Sale Safety Edits – Dated 10/23/2018

Summary: CMS provided frequently asked questions to the opioid safety edits that plans are expected to implement in 2019.  Preliminary lessons learned from the pilot of testing the opioid naïve and care coordination edit is also provided for additional guidance.   

Action: Applicable to PACE plans that adjudicates claims at the point-of-sale.  Refer to the memo for complete details.  Pharmastar will implement the safety edits selected by plan for January 1, 2019.

 

Update: PLATO Sunset – The Medicare Advantage and Part D Fraud, Waste and Abuse Tool – Dated 10/23/2018

Summary: CMS provided additional guidance to assist plans with the transition of PLATO to a “read-only” access mode.  Directions on what “Read-only” means for all PLATO users is provided.

Action: Informational to PACE plans that utilizes PLATO.  Refer to the memo for complete details.

 

October 2018 Updates to the Payment Reconciliation System (PRS) Reports – Dated 10/25/2018

Summary: CMS announced changes to the PRS reports which went into effective on October 14, 2018.  CMS will update the currently posted file layouts on the CSSC website and the TPA website. 

Action: Informational to PACE.  Refer to the memo for changes on the PRS reports.

 

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.

 

Availability of Medicare health Outcomes Survey (HOS) 2015-2017 Cohort 18 Performance Measurement Data – Dated 10/26/2018

Summary: CMS announced the release of the Medicare HOS 2015-2017 Cohort 18 Performance Measurement beneficiary level data.  The HOS data are intended to support quality improvement activities and initiatives.  Plans can obtain their data from HSAG by contacting the HOS information and technical support email provided.

Action: Informational to PACE as PACE does not participant in the Health Outcomes Survey (HOS) program.

 

Medical Loss Ratio (MLR) Report and Attestation Submission Reminder for Contract Year 2017 – Dated 10/26/2018

Summary: CMS reminds plans that the upload functionality for CY 2017 MLR Reports will be available in HPMS on November 9, 2018.  The electronic Attestation functionality for CY 2017 MLR will be available on December 10, 2018.  The CY 2017 MLR attestations must be submitted in HPMS by 11:59 PM PT on Wednesday, December 19, 2018.

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

 

Migration of the Health Plan Management System to Amazon Web Services – Dated 10/29/2018

Summary: CMS will migrate the HPMS current web hosting facility to the cloud-based Amazon Web Services during the weekend of November 17, 2018.  HPMS will be unavailable after 8PM ET on November 16, 2018 through November 18, 2018.  CMS recommends plans share this information with network administrators to ensure uninterrupted service to HPMS.

Action: Applicable to PACE. All PACE plans who were active in 2013 must complete the attestation through HPMS.

 

Medicare Advantage/Prescription Drug System (MARx) November 2018 Payment – INFORMATION – Dated 10/30/2018

Summary: CMS provided information about the November payment which is scheduled for November 1, 2018 and may require plan action:

  • CY 2017 Part D Payment Reconciliation
  • End of Year Payment Processing 2018

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

 

Update – Migration of the Health Plan Management System to Amazon Web Services – Dated 10/30/2018

Summary: CMS will migrate the HPMS current web hosting facility to the cloud-based Amazon Web Services during the weekend of November 17, 2018.  CMS will remove the CMSNet pathway as a means for accessing HPMS.  The change does not impact a plan’s use of CMSNet for accessing other CMS systems.

Action: Informational to PACE.

 

2019 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) – Dated 10/31/2018

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 2019 are attached.

Action: Informational to PACE.

 

CY 2019 Core Reporting Requirements for Medicare-Medicaid Plans – Dated 11/1/2018

Summary: CMS released the CY 2019 Medicare-Medicaid Capitated Financial Alignment Model Core Reporting Requirements.  Refer to the memo for a summary of substantive changes that were made as compared to the CY 2019 reporting requirements released.

Action: Informational to PACE as PACE is not a Medicare-Medicaid Capitated Financial Alignment Model and is waived of the Part D reporting requirements.

 

Part D Communication Materials – Dated 11/1/2018

Summary: CMS remind Medicare Advantage and Prescription Drug Plan sponsors that the guidance form the CY 2018 Medicare Communications and Marketing Guidelines still applies to all Part D communication materials. 

Action: Informational to PACE as PACE does not follow the MAPD marketing guidelines.

Thanksgiving Holiday

The Pharmastar Administrative Office will be closed on November 22nd 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

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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