Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: 2018 Program Audits
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Learn more about CMS Updates that may impact your PACE Plan.

Long-Term Institutionalized Resident Report – Dated 12/1/2017

Summary: The 2017 Long-Term Institutionalized Resident Report will be distributed on December 1, 2017.  Plans will only receive an LTI Resident Report if they have LTI enrollees.  The layout of the report is provided.

Action: Informational to PACE.  For PACE plans with LTI enrollees, refer to the memo for details on how to retrieve the report and other general report details.

 

2018 Medicare CAHPS Survey Guidance for Contracts Significantly Affected by Major Disasters – Dated 12/1/2017

Summary: CMS issued additional CAHPS survey administration guidance for contracts affected by the disasters and declarations of public health emergencies this year. 

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

 

DRAFT Medicare Prescription Drug Benefit Manual – Chapter 13 Request for Comments by January 31, 2018 – Dated 12/1/2017

Summary: CMS released draft revisions to the Chapter 13- Premium and Cost-sharing Subsidies for Low-income Individuals of the Medicare Prescription Drug Benefit Manual.  CMS will accept comments and proposed revisions on Chapter 13 through January 31, 2018.

Action: Informational to PACE.  For individuals providing feedback, refer to the memo for complete details.

 

DRAFT Medicare Prescription Drug Benefit Manual – Chapter 14 Request for Comments by January 31, 2018 – Dated 12/1/2017

Summary: CMS released draft revisions to the Chapter 14- Coordination of Benefits of the Medicare Prescription Drug Benefit Manual.  CMS will accept comments and proposed revisions on Chapter 14 through January 31, 2018.

Action: Informational to PACE.  For individuals providing feedback, refer to the memo for complete details.

 

Preparation of Administrative Case Files Related to Cumulative Morphine Equivalent Does (MED) Opioid Point-of-Sale (POS) Edits – Dated 12/1/2017

Summary: CMS request additional information when appeals are related to a plan’s cumulative MED edit.  Effective immediately, all case files sent

to the Independent Review Entity (IRE) that involves a drug or drugs subject to a plan’s cumulative MED limit are to include the following:

  • Drug claims history for the most recent 90 days.
  • Clear explanation that the request drug(s) involves the plan’s cumulative MED edit.

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

 

Medicare-Medicaid Plan Application of Deductible and Cost-sharing when Reimbursing Non-Contract Providers – Dated 12/5/2017

Summary: CMS provided clarification on Medicare-Medicaid Plans reimbursement of non-network providers for Medicare-covered services during what may have been a deductible period under fee-for-service Medicare.  

Action: Informational to PACE.

 

Fall 2017 Past Performance Results Available in HPMS – Dated 12/5/2017

Summary: The results of CMS’ review of organizations’ performance for the period of August 2016 through September 2017 are now available on HPMS.  For organizations offering both Part C and Part D, there are separate C and D results.  Viewing instructions for results are included.

Action: Informational to PACE as PACE is excluded from the performance analysis.

 

Second Plan Preview of Display Measures in HPMS – Dated 12/6/2017

Summary: The second plan preview of the 2018 Part C and D display measures will be held on December 6-12, 2017.  There have been measure data revisions and technical note updates as a result of issues found during the first plan preview.  Plans can review their data in HPMS prior to CMS posting the 2018 display measures to the CMS website.

Action: Informational to PACE as PACE is excluded from all Part C reporting requirements and waived from the Part D reporting requirements. 

 

2018 Program Audits – Dated 12/6/2017

Summary: CMS released the Program Audit Process Overview document to provide the industry with information about the changes and updates to program audits in 2018.  The 2018 version is available on the program audit website.

Action: Informational to PACE as PACE has a separate audit process protocol.

 

Guidance on Non-Contract Provider Payments for Seasonal Influenza Vaccines (2017-2018 Flu Season) – Dated 12/6/2017

Summary: CMS provided guidance on payments to non-contract providers for seasonal influenza virus vaccines that are furnished in the 2017-2018 flu season.  The Medicare Part B payment allowances for the 2017-2018 influenza vaccines pricing are in effect from August 1, 2017 to July 31, 2018.

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

 

2018 Medicare Advantage & Prescription Drug Plan Conferences Save the Date Announcement – Dated 12/8/2017

Summary: CMS announced the 2018 MA & PDP Spring, Audit, and Fall Conferences in advance to provide plans notice regarding the upcoming events.  Additional information on the conferences are forthcoming.

Action: Informational to PACE.  Refer to the email for complete details on the conferences and date announcements.

 

2018 Medicare Health Outcomes Survey Guidance for Contracts Significantly Affected by Major Disasters – Dated 12/8/2017

Summary: CMS released additional HOS survey administration guidance for plans affected by the various disasters and declarations of public health emergencies this year.  

Action: Informational to PACE.

 

Timeliness Monitoring Project (TMP) – Dated 12/12/2017

Summary: CMS will be conducting an industry wide monitoring project to collect data and evaluate for timeliness of processing of Medicare Advantage Part C organization determinations and reconsiderations and Medicare Prescription Drug Part D coverage determinations and redeterminations.  Plans active for both CY 2017 and CY 2018 will be subject to this monitoring effort.  

Action: Informational to PACE as PACE is excluded from this monitoring project.

 

Open Door Forum: Medicare Advantage Value-Based Insurance Design Model – CY 2019 Application Cycle – Dated 12/12/2017

Summary: The Medicare Advantage Value-Based Insurance Design (VBID) Model will be hosting an open-door forum on December 13th to discuss the recently announced opportunity to apply for the CY 2019 VBID Model.

Action: Informational to PACE as PACE is not eligible to participate in the Value-based Insurance Design model.

 

Guidance to Enrollees about the New Medicare Card Project – Dated 12/14/2017

Summary: CMS provided information on how plans should handle questions from enrollees regarding the new Medicare cards.  New Medicare numbers will be assigned to all Medicare recipients and new Medicare cards will begin to be mailed to all people with Medicare in April 2018.

Action: Applicable to PACE.  All PACE Medicare recipients will be receiving new Medicare cards.  Refer to the email for complete details.

 

Extension of Special Enrollment Period for Individuals Affected by Hurricanes in Puerto Rico and U.S Virgin Islands and California Wildfires – Dated 12/14/2017

Summary: CMS provided additional opportunities for individuals affected by the recent hurricanes and wildfires to join, drop or switch Medicare health and prescription drug plans.  Medicare beneficiaries affected are eligible for a special enrollment period through March 31, 2018.

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

 

Holiday Hours

The Pharmastar Administrative Office will be closed on December 25th and January 1st.  As always, the 24/7 Pharmastar help desk will remain open for your needs throughout the coming holidays at 888-298-7770.

Member Enrollment

Due to the holidays, we remind plans to send Pharmastar notifications for any new and/or updated member enrollment early to prevent any delays over the holiday. 

 

Important Date Reminders

Date

      Item

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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