Learn more about CMS Updates that may impact your PACE Plan. FEATURED UPDATE: Release of Contract Approval Status Report
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Invitation to Provide Feedback on the Contract Year 2018 Bid Pricing (Actuarial) Requirements – Dated 8/11/2017

Summary: CMS is seeking comments and suggestions on the Contract Year (CY) 2018 actuarial bid process.  Feedback period will take place from August 14 through August 25, 2017.  Comments can be submitted via the website provided.

Action: Informational to PACE.

 

Release of Contract Approval Status Report – Dated 8/11/2017

Summary: CMS released the Contract Year 2018 Contract Approval Status Report in HPMS.  Organizations can use the report to identify proactively where incomplete data entry or submissions may preclude CMS from approving your contract for the upcoming contract year.  Organizations are encouraged to access this report.

Action: Informational to PACE.

 

Contract Year (CY) 2018 “Medicare & You” Handbook – Plan Data Preview – Dated 8/11/2017

Summary: CMS is providing organizations the opportunity to preview how their plan data will appear in the Contract Year 2018 “Medicare & You” handbook.  The preview period will be August 17 through August 21, 2017.  Plans are strongly encouraged to review their data early to ensure any updates are reflected in a timely manner.

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

 

Retail Pharmacy Network Access and Preferred Cost-Sharing Pharmacy Network Access Analysis Results for Q2 of CY 2017 – Dated 8/11/2017

Summary: CMS released the retail pharmacy access analysis for Q2 for 2017.  Plans have the opportunity to review the data and submit questions and/or concerns to CMS prior to CMS publishing the data to the CMS webpage.

Action: Informational to PACE.

 

MAO Coverage of Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) – Dated 8/12/2017

Summary: For Calendar Years 2017 and 2018 only, original fee-for-service Medicare will pay for reasonable and necessary items and services obtained for beneficiaries enrolled in MA plans for supervised exercise therapy (SET) for symptomatic peripheral artery disease. Plans should account for these items and services in their contract year 2019 bids. 

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

 

Reporting Requirements for 2018 HEDIS, HOS, and CAHPS Measures – Dated 8/14/2017

Summary: CMS released the 2018 Performance Measure Reporting Requirements for all health plan organizations.  Specific submission dates are listed to ensure plans comply with the reporting(s) that are applicable to their plan.  

Action: The HOS-M survey applies to PACE.  PACE plans in effect on or before January 1, 2017 and with a minimum of 30 members are required to administer the HOS-M survey in 2018.  Refer to the memo for complete details.

 


8 Important Reports a PACE Organization Should Receive


Plan Connectivity Data Submissions in HPMS – Dated 8/15/2017

Summary: All plans that utilize a third party to transfer data to/from CMS are responsible for providing and maintaining their third party information within the PCD module.  CMS encourages plans to complete the data entry and email submission no later than August 25, 2017 for approval of contracts for CY2018.

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

 

Contract Year 2018 Annual Notice of Change/Evidence of Coverage Submission Requirements and Yearly Assessment – Dated 8/17/2017

Summary: CMS reminds plans on the key actions required for the Annual Notice of Change/Evidence of Coverage (ANOC/EOC) documents.  The ANOC/EOCs provide vital information to enrollees regarding benefits and cost-sharing.  CMS expects plans to send correct ANOC/EOCs to enrollees on time and in accordance with Medicare guidelines. Additional information on the ANOC/EOC instructions and Model Errata can be found in the link provided.

Action: Information to PACE as PACE is waived of the ANOC/EOC requirements.  Refer to the memo for complete details.

 

Release of the Contracts and Addenda for Contract Year (CY) 2018 – Dated 8/17/2017

Summary: CMS updated the Contract Year 2018 Contracts and Addenda to the HPMS Electronic Contracting Module.  Plans must execute contracts via the electronic signature process in HPMS by August 31, 2017.

Action: Informational to PACE as the guidance provided is not applicable to PACE plans.

 

Changes to Payment Year (PY) 2016 Final Model Output Report (MOR) – Dated 8/17/2017

Summary: CMS distributed the MOR to plans to identify the Hierarchical Condition Categories (HCC) used to calculate risk scores for each beneficiary.  Information regarding these reports and the changes to the MOR for 2016 final payment is provided.

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

 

 

Changes to the Medicare Advantage QIP and CCIP Requirements – Dated 8/18/2017

Summary: CMS notified MAOs of changes to the Quality Improvement Project and Chronic Care Improvement Program requirements.  A FAQ is attached to provide additional information.

Action: Informational to PACE.

 

CY 2018 Formulary-Level Cumulative Opioid Morphine Equivalent Dose (MED) Point of Sale (POS) Edit – Dated 8/18/2017

Summary: CMS expects plans to implement either a soft and/or hard opioid edit based on MED at the POS.  Part D plans must complete the attached template and submit to HPMS before September 1, 2017 5pm EST.  CMS also expects plans to have a written policy on the opioid edits at the POS that CMS may request for review at any time.

Action: Applicable to PACE plans if they adjudicate claims at POS.  Pharmastar will implement edits at the POS for the cumulative MED daily dose threshold and can assist your plan with completing the template as appropriate.

 

Sensipar (cinacalcet) Furnished for the Treatment of ESRD Moving from Part D to ESRD PPS, Effective January 1, 2018 –Dated 8/18/2017

Summary: CMS provided an update to plans regarding Sensipar (cinacalcet) used for the treatment of ESRD.  Effective January 1, 2018, Parasabiv (etelcalcetide) and Sensipar (cinacalcet) will both be included in the ESRD PPS when used for the provision of renal dialysis services. 

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

 

CGDP Preliminary Labeler Code Changes for Calendar Year 2018 Update – Dated 8/22/2017

Summary: The list of anticipated Coverage Gap Discount Program labeler changes scheduled for January 1, 2018 will include:

Additions:

55466 Neolpharma Inc.

55494 Duchesnay USA, Inc.

61894 Symplmed Pharmaceuticals.

65799 Intarcia Therapeutics, Inc.

66220 Cumberland Pharmaceuticals Inc.

69051 Profounda, Inc.

69468 Wellstat Therapeutics Corporatio

70636 Cutanea Life Sciences, Inc.

70436 Slate Run Pharmaceuticals, Inc.

70482 Adamas Pharmaceuticals Inc.

70720 TerSera Therapeutics LLC.

71332 Rigel 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 has made the necessary software adjustments to accommodate for the updated codes.

 

Registration Update: In-person Registration for CMS’ 2017 Fall Conference & Webcast is Closing – Dated 8/24/2017

Summary: CMS reminds plans who are attending the conference & webcast in-person to register by Friday, August 25th at 6pm EST.  

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

 

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

January 1, 2018

Sensipar- ESRD Treatment must be included in the ESRD PPS & no longer payable under Part D benefit.

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

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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