CMS Updates for the week of 11.9.2015
            
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Updated: Reporting Requirements for 2016 HEDIS, HOS and CAHPS Measures, Adding Two Asthma Measures to Table 2– Dated 10/09/15-Missed Memo

Summary: HEDIS measures required for reporting in 2016 have been revised to include two additional measures in Table 2: MMA, Medication Management for People with Asthma and AMR, Asthma Medicare Ratio. Aside from the two additions to Table 2 on Page 3, this memorandum is identical to the August 7, 2015 Memo.

Action: Applicable to PACE plans.


 

Contract Year 2016 Monitoring of Marketed Comprehensive Formularies– Dated 10/26/15

Summary: CMS evaluated whether Part D sponsors followed the requirements for disseminating Part D information in CY 2015 and intends to do so in CY 2016. MAOs, MMPs and Prescription Drug Plan sponsors offering Part D must included on their website their current formulary including tier level, limited access indicator and applicable quantity limit restrictions, prior authorization, and step therapy requirements.

Action: Informational to PACE plans. Refer to the memo for further information on CY 2016 Monitoring, CY 2015 results, and other steps Part D sponsors must take with step therapy and prior authorizations.


 

VBID: Actuarial Guidance– Dated 10/27/15

Summary: Actuarial guidance for the Medicare Advantage Value-Based Insurance Design model test is now available. The online portal for responses to the Request for Application is also open for registration. Both may be accessed from the model’s webpage.

Action: Not applicable to PACE plans.


 

Medical Loss Ratio Report and Attestation for Contract Year 2014-Submission Reminder and Additional Guidance for Contracts that Terminated, Consolidated or Withdrew in CY 2014– Dated 10/27/15

Summary: MLR Reports and electronic Attestations will be available in HPMS beginning November 6, 2015. The CY 2014 MLR Reports and Attestations must be submitted by 11:59 PM (PT) on Friday, December 4, 2015. 

Action: Informational to PACE plans. Each MAO, Cost Plan, and Part D Sponsor is required to submit an MLR report to CMS for each contract year. Please follow the link in the memo for further direction.


Proposed Changes to the CMS-HCC Risk Adjustment Model for Payment Year 2017– Dated 10/28/15

Summary: CMS has undertaken an evaluation to assess how well the model performs for dual eligible beneficiaries. As stated in the 2016 Rate Announcement, concerns are taken very seriously especially when it may disproportionately affect specific populations, particularly dual eligible. An evaluation will occur and the analysis will be shared with stakeholders. If appropriate, modifications will be proposed to the model to improve predictive accuracy in a future year’s process. 

Action: Applicable to PACE plans. Comments are invited and should be submitted by November 25, 2015 to RiskAdjusment@cms.hhs.gov.


 

Part D Enhanced Medication Therapy Management Model Request for Applications – Dated 10/28/15

Summary: On September 28, 2015 CMS announced the Enhanced MTM Model, a test of Part D program flexibilities that will align PDP sponsor interests with the goal of producing savings for the Medicare program. Please see the attachment for the Request for Application for the Enhanced MTM Model test.

Action: Informational to PACE plans. Additional information on the application process and other guidance will be provided as soon as it’s available on the model website listed in the memo.


Coverage Gap Discount Program: November Participating Labeler Code Update – Dated 10/28/15

Summary: CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program by November 1, 2015. The updates include:

  • 68791 Royal Pharmaceuticals LLC

Updates will be posted to CMS website in bold red.

Action: Applicable to PACE plans. Pharmastar has updated there Part D medications list to reflect these changes. 


 

Proposed Changes to the CMS-HCC Risk Adjustment Model for Payment Year 2017 – Dated 10/28/15

Summary: CMS has undertaken an evaluation to assess how well the HCC risk adjustment model performs for dual eligible beneficiaries. As stated in the 2016 Rate Announcement, concerns raised by commenter’s are taken very seriously as this could disproportionately affect specific populations, particularly dual eligible. There will be an evaluation on this particular model and if appropriate, propose modifications to the model to improve predictive accuracy in a future year’s process. 

Action: Applicable to PACE plans. 


November 2015 Updates to the Drug Data Processing System– Dated 10/29/15

Summary: CMS is announcing upcoming changes to the DDPS. The implementation date for these changes is November 8, 2015. Prior to the implementation of these changes, CMS will post an updated PDE Code Listing spreadsheet to the CSSC Operations website. 

Action: Applicable to PACE plans. Please submit questions regarding these updates to PDEJan2011@cms.hhs.gov.


 

Availability of Medicare Health Outcomes Survey 2012-2014 Cohort 15 Performance Measurement Data– Dated 10/30/15

Summary: Medicare Health Outcomes Survey Team has announced that the Medicare HOS 2012-2014 Cohort 15 Performance Measurement beneficiary level data are available for those organizations which continue to participate in the MA program. This will be the 14th release of the beneficiary level HOS data to MAOs. HOS data supports quality improvement activities and initiatives. 

Action: Not applicable to PACE plans. Each participating MAO must obtain their data from the Health Services Advisory Group by contacting the HOS Information and Technical Support via email at hos@hcqis.org .


 

Request for Comment on Revisions to Core Measure 9.2– Dated 10/30/15

Summary: CMS previously released the MMP Core Reporting Requirements for CY 2015 via HPMS memo. CMS had received several questions regarding Core Measure 9.2-Nursing Facility Diversion, thus has revised the specifications for this measure to improve clarity. 

Action: Informational to PACE plans. Please provide comments using the provided template by November 9, 2015 to the Medicare-Medicaid Coordination Office.  


 

 

Suspension of ICD-10 Daily Reporting– Dated 10/30/15

Summary: This email was sent out to inform all Medicare Advantage Organizations that they may suspend their daily ICD-10 readiness reporting to their Account Manager effective Monday, November 2, 2015. October 30, 2015, will mark the final day that MAOs should report on ICD-10 readiness. Thank you to all MAOs for your participation in reporting over the last month. 

Action: Not Applicable to PACE plans. 


 

Agent/Broker Compensation– Dated 10/30/15

Summary: This email is to update and clarify payment guidance in the Medicare Marketing Guidelines. The three scenarios affecting how an organization may pay full or pro-rated initial compensation are as follows:

  1. Beneficiaries in their first year enrollment in a plan, in which the MARx report lists prior plan type as “none”, may pay full or pro-rated initial compensation.
  2. If a beneficiary moves from employer group to a non-employer group plan, in which the MARx report lists prior plan type as “none”, may pay full or pro-rated initial compensation.

For unlike plan changes (e.g. MA-PD to PDP or PDP to Cost Plan), occurring after January 1 in which the MARx report indicates the beneficiary had prior plan history(regardless of plan type), organizations must pay pro-rated initial compensation according to number of months in the plan. 

Action: Not applicable to PACE plans. CMS expects organizations to immediately correct their processes and to provide agents/brokers with notification of payment requirements.


 

Public Reporting of Medicare Advantage Special Needs Plans Models of Care– Dated 11/03/15

Summary: Medicare Advantage SNP CY 2016 Models of Care are posted for the public on a new website: http://www.snpmoc.org .The website includes:

  • MOC score list
  • MOC standards
  • Scoring details on each MOC standard and element at the contract level
  • MOC scoring guidelines.

The website provides general information and resources regarding MOC training and technical assistance. 

Action: Informational to PACE plans. 


 

Updated Hospice File Available – Dated 11/04/15

Summary: CMS would like to notify all Medicare Part D plans that the hospice contact list has been updated and is available through HPMS. To access the file from HPMS home page, choose Data Extract Facility, then Contact Information. The Hospice Contract Information file is listed in the first drop-down box. 

Action: Informational to PACE plans. If you are unable to access settings. Please contact HPMS_Access@cms.hhs.gov .