Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: 2017 Contract Year COB Requirements Preparation
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Learn more about CMS Updates that may impact your PACE Plan.

Coverage Gap Discount Program: August Participating Labeler Code Update – Dated 7/28/2017

Summary: CMS will update the below participating manufacturer labeler codes for the Coverage Gap Discount Program by August 1, 2017 to include:

Added:

71558 Insmed Incorporated

69853 Portola Pharmaceuticals, Inc.

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 will make the necessary software adjustments to accommodate for the change.

 

Medicare Advantage/Prescription Drug System (MARx) August 2017 Payment – INFORMATION – Date 7/28/2017

Summary: CMS released information about the August payment and other payment related items that may require plan action:

  • Second 2011 Part D Reopening
  • 2017 Mid-Year Risk Adjustment Reconciliation
  • Missing Records on the Late Enrollment Penalty Data File (LEPD)

Action: Informational to PACE plans.  Refer to the memo for items applicable to your plan.

 

Advance Announcement of the November 2017 Software Release – Dated 7/28/2017

Summary: CMS continues to implement software improvements to the enrollment and payment systems that support Medicare Advantage and Prescription Drug programs (MAPD).

The plan released of systems changes scheduled for November 2017 include the following:

  • New Medicare Care Project-MARx Data File/Report Changes
  • Centers for Medicare & Medicaid Services Enterprise Portal Changes

Action: Applicable to PACE plans. Refer to the memo for further information on the released system changes.

 

Annual Release of the Part D National Average Bid Amount and other Part C & D Bid Information – Dated 7/31/2017

Summary: CMS provided the determination of the amounts for the following:

  • Part D Beneficiary Premium
  • Part D National Average Monthly Bid Amount
  • Part D Regional Low-Income Premium Subsidy Amounts
  • Part D Income Monthly Adjustment Amounts
  • De Minimis Amount
  • Medicare Advantage EGWP Regional Payment Rates
  • Medicare Advantage Regional Benchmarks

Action: Informational to PACE as this does not apply to PACE plans.

 

Invitation to Provide Feedback on the Contract Year 2018 Formulary Submission – Dated 7/31/2017

Summary: CMS requested plans to provide feedback on the Contract Year (CY) 2018 formulary submission process in HPMS.  Feedback can be submitted from July 31, 2017 through August 4, 2017.  Access to HPMS is not required.

Action: Informational to PACE plans that utilized a formulary and submitted a formulary for CY 2018.

 

New “Contact Us” Feature in the Health Plan Management System (HPMS) – Dated 7/31/2017

Summary: CMS released a new feature in HPMS to allow users to submit questions online in regards to HPMS technical support or HPMS user access.

Action: Informational to PACE.

 

Contract Year (CY) 2018 Final Actuarial Certification Deadline – Dated 8/1/2017

Summary: As part of the Contract Year (CY) 2018 bid submission requirements, an actuarial certification must be submitted via the HPMS actuarial certification module for every Bid Pricing Tool uploaded to HPMS.  Certifying actuaries were required to complete the initial certification process in June and all final certifications are to be completed by August 11, 2017.  If a certification is not submitted via HPMS, the bid(s) will not be considered for CMS review or approval. 

Action: PACE plans should review the status of this requirement with their actuaries.  Refer to the memo for complete details.

 

Disability Competence Resources Available from the Office of Minority Health and the Medicare-Medicaid – Dated 8/1/2017

Summary: CMS invites plans to explore new and existing resources to support providers and health plans provide person-centered care for individuals with disabilities.  CMS is pleased to share new reports that are relevant to the clinical care of and care coordination of individuals with disabilities. A list of the resources to increase understanding of health equity issues affecting people with disabilities is provided.

Action: Informational to PACE.

 

CMS’ 2017 MA & PDP Fall Conference & Webcast Audit & Enforcement Conference & Webcast Announcement Update – Date 8/1/2017

Summary: CMS announced the 2017 Medicare Advantage & Prescription Drug Plan Fall Conference & Webcast.  The all-day event will be held on September 7, 2017.  A listing of session topics is provided.

Action: Informational to PACE.  For those interested in participating, refer to the attachment in the email for complete details and how to register.

 

Revised Notice of Denial of Medicare Part D Prescription Drug Coverage (CMS-10146) – Dated 8/1/2017

Summary: CMS announced the revised OMB-approved standardized Notice of Denial of Medicare Part D Prescription Drug Coverage (CMS-10146). All plans offering Part D must use the revised version beginning no later than October 1, 2017.  The revised notice must be provided to Part D enrollees when a plan issues a fully or partially adverse coverage determination.  The notice and accompanying instructions are included in a link in the memo.

Action: Informational to PACE as PACE has its own Grievance and Appeals process.

 

CY 2018 Medicare Advantage Out-of-Pocket Costs & Premium Information for Rebate Reallocation – Dated 8/1/2017

Summary: CMS released information in HPMS on the CY 2018 Medicare Advantage (MA) Out-of-Pocket values by service category and premium amounts based on the national average to assist in preparing bid submission during rebate reallocation.  

Action: Information to PACE.

 

2017 Contract Year COB Requirements Preparation – Dated 8/3/2017

Summary: CMS announced the release of the upcoming annual full replacement COB file to begin on August 21, 2017.  Each plan will receive a full replacement COB file for all enrollees with other coverage. Plans are expected to review the file and enter selected updates of other health insurance into ECRS as they become aware of the changes.  Furthermore, CMS specific the location of where plans should reference the effective dates of the other coverage on the COB files.

Action: Applicable to PACE.  Refer to the memo for complete details of the COB requirements in preparation for the annual full replacement COB file. 

 

Welcome to the Health Plan Management System (HPMS) Video Presentation – Dated 8/3/2017

Summary: CMS released a new “Welcome to the Health Plan Management System” video presentation on the CMS YouTube channel to provide a high-level overview of HPMS.  The link to the video is provided.

Action: Informational to PACE.

 

2017 Medicare Health Outcomes Survey (HOS) HPMS Update – Dated 8/4/2017

Summary: CMS announced the release of the update HPMS HOS module and availability of the reports and data to participating Medicare managed plans on the following:

  • 2014-2016 Cohort 17 Medicare HOS Performance Measurement Report
  • 2014-2016 Cohort 17 Medicare HOS Star Ratings Validation
  • 2014-2016 Cohort 17 Medicare HOS Aggregate Score Analysis

Action: Informational to PACE as PACE plans do not participant in the Health Outcomes Survey program.

 

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Availability of 2016 Medicare Health Outcomes Survey-Modified (HOS-M) Electronic Data – Dated 8/4/2017

Summary: CMS announced the availability of HOS-M 2016 beneficiary level data to PACE organizations that participated in the Health Outcomes Survey-Modified program.  Instructions for participating plans on how to request their data is provided.

Action: Applicable to PACE plans who participated in the program.  Refer to the memo for complete details.

 

August 2017 Updates to the Drug Data Processing System (“DDPS”) and the Payment Reconciliation System (“PRS”) – Dated 8/7/2017

Summary: CMS modified the following for the Drug Data Processing System (DDPS) and the Payment Reconciliation System (PRS) which will go into effective on August 13, 2017:

  • Changes to Edit Code 712- if a PDE receives edit code 714 and is a P2P PDE, it may also receive an edit code 712 in which the submitting contract is informed to check their records and make updates to the beneficiary’s enrollment information if necessary.
  • Changes to PDE Potential Exclusion Warning Reports and PDE Exclusion Reports- if a contract is terminated and have received their Final Settlements from CMS, the plan will no longer receive PDE Potential Exclusion Warning Reports and Exclusion Reports for reopened reconciliations.  

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

 

Plan Preview Dates for 2018 Medicare Plan Finder – Dated 8/9/2017

Summary: CMS provided a timeline and instructions for Medicare Advantage Organizations, Prescription Drug Plans, and Section 1876 Contractors to preview plan benefit cost sharing data and out of pocket estimates to ensure plan data displays accurately on Medicare Plan Finder (MPF).  Plans should access and review their plan data prior to the closing of the preview periods on August 25 and September 8, 2017.  The 2018 MPF is scheduled to go live on October 1, 2017.

Action: Applicable to PACE.  Though PACE plans do not need to submit their pricing and benefit information in MPF, PACE plans should ensure that their data (PACE organization name and contact information) is displayed accurately.  Refer to the memo for complete details.

 

CMS’ 2017 MA & PDP Fall Conference & Webcast Announcement Update – Dated 8/9/2017

Summary: CMS made updates to the 2017 Medicare Advantage & Prescription Drug Plan Fall Conference & Webcast.  The all-day event will be held on September 7, 2017.  A listing of the updates is included.  

Action: Informational to PACE.  For those interested in participating, refer to the attachment in the email for complete details and how to register.

 

Updated Dataset for First Plan Preview of 2018 Star Ratings Data – Dated 8/10/2017

Summary: CMS updated the dataset in HPMS for the first 2018 Star Ratings Plan Preview on August 10, 2017.  The first plan preview comment period will end on August 18, 2017.

Action: Informational to PACE as PACE plans do not participant in the MA plan Star Ratings.

 

Important Date Reminders

Date

      Item

September 2017*

2016 Attestations of PDE, DIR Data, P2P Reconciliation Payments and Detailed DIR Report Submission Period

August 21 –

September 1, 2017

CY 2018 Formulary-Level Cumulative Opioid MED POS Edit Template Submission Period

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

Enforcment Date for the Prescriber Enrollment Requiremen

*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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