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

Auto-Assignment of New HPMS EUA Job Code to Existing HPMS Users – Dated 11/16/2018

Summary: CMS established a new EUA job code for HPMS production website access which will be assigned to all existing HPMS users. No action is required at this time.

Action: Informational to PACE.

CMS Health Equity Award: Submit Nominations by December 7 – Dated 11/16/2018

Summary: CMS is looking for nominations for the CMS Health Equity Award which is to be given at the Quality Conference 2019 to recognize organizations demonstrating a commitment to health equity by reducing disparities among CMS beneficiaries. Nomination forms are due no later than December 7, 2018.

Action: Informational to PACE.

November Actuarial User Group Call and Release of CY 2020 BPT Updates – Dated 11/16/2018

Summary: CMS will host an actuarial user group call on November 29th to review the CY 2019 bidding process, discuss potential changes for CY 2020 Bid Pricing Tools and corresponding instructions and questions on preparing the CY 2020 bids.

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

Plan Review of the 2019 Display Measures in HPMS – Dated 11/19/2018

Summary: CMS announced the availability of the display measures for Part C and D plans which can be previewed in HPMS prior to posting on the CMS website from November 20- December 6, 2018. Comments and questions on the display measures can be sent to CMS no later than December 6, 2018.

Action: Informational to PACE.

Part D Drug Management Program Policy Guidance – Dated 11/20/2018

Summary: CMS provided a comprehensive policy guidance for implementation of the Part D Drug Management Programs (DMPs). The document incorporates the extensive guidance CMS provided in the final rule for DMPs and additional details. DMPs are currently voluntary under the CARA Act but will be required for all Part D plans beginning on or after January 1, 2022.

Action: Applicable to PACE plans who had voluntarily selected to implement DMPs in 2019 based on their response submitted on the CY 2019 Opioid Template Submission. Refer to the memo for complete details and take the actions applicable to your plan.

Early Preview – CY2020 Medicare Advantage Ratebook Growth Rates– Dated 11/27/2018

Summary: CMS released the CY 2019 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.

Discontinuation of Approval Process for SNP Health Risk Assessment Tool – Dated 11/27/2018

Summary: CMS informed SNPs that they will no longer be required to submit the Health Risk Assessment Tool to CMS for approval. SNPs are expected to document any changes and make it available upon request.

Action: Informational to PACE as this applies only to Medicare Advantage Special Needs Plans.

November 2018 Updates to the Drug Data Processing System (DDPS)– Dated 11/28/2018

Summary: CMS announced the following upcoming changes to the DDPS.

  • Changes to the monthly implementation timeline for the FDA NDC SPL Data Elements (NSDE)
  • PDE editing for biosimilar drugs

An updated PDE Error Code Listing spreadsheet will be posted on the CSSC Operations website for these changes.

Action: Informational to PACE.

 Christmas Holiday

The Pharmastar Administrative Office will be closed early on December 24th at 12PM CT and on December 25th in celebration of the Christmas 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

Initial Preclusion List Available

April 1, 2019

Payment Denials and Claims Rejections Begin for the January 1, 2019 Preclusion List

*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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