Not rendering correctly? View this email as a web page here.


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

Encounter Data Software Releases – Dated 8/25/2017

Summary: CMS released information on the software improvements made to the systems that collect and process encounter data. Changes to be implemented on September 29, 2017 include corrections or modifications to the logic for existing edits to align with program policies and implementation of new edits.  

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


Reminder of Pharmacy and Provider Access during a Federal Disaster or Other Public Health Emergency Declaration – Dated 8/29/2017

Summary: CMS reminds plans their obligations to maintain access to Medicare benefits for beneficiaries in areas that have been affected by Hurricane Harvey. 

Action: Applicable to PACE.  Refer to the memo for complete details.  Plans affected by the disaster and need to lift their edits should contact Pharmastar.


Frequently Asked Questions Regarding Accessible Communications for Individuals with Disabilities Pursuant to Section 504 of the Rehabilitation Act of 1973 and Section 1557 of the Affordable Care Act – Dated 8/30/2017

Summary: CMS provided responses to questions about accessible communications for individuals with disabilities.  

Action: PACE plans are required to comply with Section 504 and provisions relevant to non-discrimination based on disability in Section 1557.  Refer to the FAQ for complete details on what is expected. 


Plan Payment for September 2017 – INFORMATION – Dated 8/30/2017

Summary: CMS released information about the September payment scheduled for September 1, 2017 that may require plan action regarding the National Medicare Education Campaign/Coordination of Benefits (COB) User Fees. 

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

Follow Pharmastar on Twitter!

2018 Full Risk Contact Option Election – Dated 8/31/2017

Summary: CMS reminds plans that they have the choice of payment options for enrollees who have 12 months of entitlement to Part A and less than 12 months of Part B enrollment during the data collection year.  Plans can be paid for these enrollees as either “full risk” or “new enrollee” beneficiaries.  Plans can choose this option for their Part C and Part D risk scores.  Organizations that wish to elect the Full Risk option for their Part A-only enrollees may access the Full Risk Contract Option Election Data in HPMS by September 22, 2017.

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


Long-Term Institutionalized Resident Report – Dated 9/1/2017

Summary: The memo announced the distribution of the third 2017 Long-Term Institutionalized (LTI) Resident Report on September 1, 2017 to plans who have LTI enrollees. 

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.


2016 Attestations of Prescription Drug Event Data (PDE), Direct and Indirect Remuneration (DIR) Data, Monthly Plan-to-Plan (P2P) Reconciliation Payments, and the Detailed DIR Report – Dated 9/1/2017

Summary: CMS requires all plans that were active in 2016 to electronically sign and attest to the below Part D data in HPMS:

-2016 Data Relating to CMS Payment to Medicare Part D Sponsor

-2016 Data Relating to Detailed DIR Report

-2016 Record and Attestation of P2P Reconciliation Payments

Completion of the Record of P2P Reconciliation Payments must be uploaded to HPMS at the same time the Plan to Plan Reconciliation Payment Data is signed. The attestations will be available through HPMS on September 5 to September 19, 2017 noon ET and is to be signed by the CEO, CFO, or COO.  

Action: Applicable to PACE.  Refer to the memo for complete details on how to complete the attestations.  Your Pharmastar Client Support Specialist can assist with the Record of P2P Reconciliation Payments.


Results of the 2017 Part C and D Reporting Requirements Data Validation – Dated 9/1/2017

Summary: CMS released the results of the data validation reviews for CY 2016 Medicare Part C and D data which was conducted on April 1, 2017 and June 30, 2017.

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


Coverage Gap Discount Program: September Participating Labeler Code Update – Dated 9/6/2017

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

Deleted- 11399 GTx, Inc.

Added- 69865 Depo NF Sub, LLC

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.  


Second Plan Preview of 2018 Star Ratings Data – Dated 9/7/2017

Summary: CMS informs plans that they can preview their Star Ratings data in HPMS prior to the display on Medicare Plan Finder.  The second plan preview begins on September 8, 2017 to September 18, 2017 5PM ET.  The final Star Ratings can be viewable by beneficiaries on in October.

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


Release of the Contract Year (CY) 2018 Plan Correction Module – Dated 9/8/2017

Summary: CMS released the HPMS Plan Correction Module for Medicare Advantage Organizations, Medicare Prescription Drug Plans and 1876 Cost Plans.  The correction module will be open from September 8, 2017 until September 21, 2017 at 11:59 PM ET.  Only changes to the Plan Benefit Package that are supported by the Bid Pricing Tool are allowed during the plan correction period.

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


Important Date Reminders



September 5, – September 19, 2017 Noon ET.

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

A real person always answers the phone at Pharmastar.
Sometimes the most important questions happen after normal business office hours. That’s why you can always talk to one of our pharmacy technicians 24/7/365 simply by calling us at (888) 298-7770.