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

Release of 2019 Part C & D Regulation for Public Comment – Dated 11/16/2017

Summary: CMS released the proposed revisions to the Medicare Advantage program and prescription drug benefit program for Calendar Year 2019 on November 16, 2017.  The comment period will close at 5pm on January 16, 2018.

Action: Informational to PACE.  Refer to the email for complete details and the link to the regulation.

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November Actuarial User Group Call and CY2019 BPT Updates – Dated 11/17/2017

Summary: CMS Office of the Actuary will host an actuarial user group call on November 28, 2017 to review the CY 2018 bidding process, discuss potential changes for CY 2019 Bid Pricing Tools, and respond to questions from industry actuaries.  A link to the agenda as well as participant dial-in information is referenced in the memo.

Action: Informational to PACE.


Early Preview- CY 2019 Medicare Advantage Ratebook Growth Rates – Dated 11/27/2017

Summary: CMS released the CY 2018 premium determination estimates of the United States Per Capita Cost for beneficiaries entitled to Part A and/or enrolled in Part B.  The estimates are preliminary and could change.

Action: Informational to PACE.


2019 Application Cycle Past Performance Review Methodology Draft – Dated 11/28/2017

Summary: CMS published the draft 2019 Past Performance Assessment Review methodology and is seeking comments which will be considered when the final version is publish.  Comments can be submitted by December 21, 2017.

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


Coverage Gap Discount Program: December Participating Labeler Code – Dated 11/29/2017

Summary: CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program by December 1, 2017 to include 46287 CMP Pharma.

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.


Coverage of Part A and B Services: Medicare Diabetes Prevention Program Expanded Model – Dated 11/29/2017

Summary: CMS recommends plans to notify enrollees of the effective date of the Medicare Diabetes Prevention Program (MDPP) which are to be covered for eligible Medicare beneficiaries under all Medicare health plans beginning on April 1, 2018.  Plans can notify enrollees by newsletter or other mass mailing and by updating the contract year 2018 Evidence of Coverage online to include the April 1, 2018 effective date.

Action: The MDPP is applicable to PACE plans. Refer to the link provided in the email for additional information on the MDPP.


Technical Issue Concerning the Payment Year (PY) 2016 Final Model Output Reports (MORs) – Dated 11/29/2017

Summary: CMS had identified a technical issue that affected how several fields were populated on the Model Output Reports (MORs) for the 2016 final payment.  The technical issue is isolated to record types “C” and “F” for the CMS-HCC Aged/Disabled model. 

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


Medicare Advantage/Prescription Drug System (MARx) December 2017 Payment – INFORMATION – Dated 11/30/2017

Summary: CMS released information on the December payment which is schedule for December 1, 2017 and may require plan action:

  • Coverage Gap Discount Invoice Offsets
  • MARx Operating Calendar for 2018
  • 2018 User Fees

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


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 1, 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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