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Contract Year 2017 MA and Part D Bid Pricing Tool Beta Testing– Dated 02/12/2016

Summary: CMS will be conducting beta testing of the draft CY 2017 Bid Pricing Tool. Testing will take place on Monday, February 22, 2016 until Friday, March 4, 2016. The draft for the CY 2017 bid forms and instructions have been posted to the CMS website.

Action: Informational to PACE plans. Please refer to the memo for the link.

 

February Actuarial User Group Call– Dated 02/12/16

Summary: CMS Office of Actuary will be hosting an actuarial user group call on Thursday, February 25, 2016, 11:00AM-12:00PM ET. The purpose of the call will be to discuss CY 2017 bidding and to respond to questions from industry actuaries who will be preparing CY 2017 bids. 

Action: Informational to PACE plans. Participant Dial-In Number is 877-251-0301 followed by the conference ID Number 36141230. 

 

Obtaining Access to the Part D Payment Process Support Website– Dated 02/16/16

Summary: CMS is providing updated instructions to obtain access to the Part D Payment Process Support Website as a result of the new Part D overpayment reporting process and reopening request process. October 24, 2013, CMS announced that Acumen, LLC would be assisting CMS with the Medicare Prescription Drug Benefit final Part D payment process. As discussed in a December 29, 2015 Memo, Part D sponsors will report PDE/DIR overpayments and request a reopening by submitting a reopening request form and any supporting documentation to the Part D Payment Support Website. 

Action: Applicable to PACE plans. Each sponsor must establish access to the Part D Payment Process Support website and instructions for obtaining access. For further direction please refer to the memo. 

 

Updated Plan Contact Information for TrOOP Coordination– Dated 02/18/16

Summary: CMS would like to inform Part D Sponsors that a new contact type has been created called TrOOP Coordination Contact within the HPMS. The TrOOP Coordination Contact has been established to identify the entities providing TrOOP coordination and balance information to Relay Health on Part D plans’ behalf for current and prior years. This will enable CMS to resolve TrOOP-related inquiries expeditiously. Part D sponsors should update this information in HPMS, as soon as possible. 

Action: Applicable to PACE plans. Refer to the email for the link to follow to update your TrOOP information within HPMS. 

 

CMS Guidance and Timeline for Contract Year 2017 Contract Consolidations– Dated 02/18/16

Summary: CMS encourages MAOs operating more than one MA or MA-PD contract of the same product type under the same legal entity to consolidate those contracts under a single contract ID for CY 2017.

Action: Informational to PACE plans. Please review the memo for further information on which MA product types are included in this consolidation. Note-CMS does not permit the consolidation of different product types under a single contract ID. 

 

Guidance on Notification Requirements for Programs of All-Inclusive Care for the Elderly Organization Change of Ownership – Dated 02/18/16

Summary: CMS has provided this memo as guidance to PACE organizations on the notification requirements for a PACE Change of Ownership (CHOW). CMS has stated in the event of a PACE CHOW, the current PACE organization must submit its notification letter on organization letterhead to include the contract IDs. Once all documents are received, CMS will need sufficient time to determine whether the acquiring entity meets statutory and regulatory requirements for entering into a PACE program agreement. 

Action: Applicable to PACE plans. The existing PACE organization should contact its CMS account manager for additional details on how the acquiring entity would qualify through the PACE application process. 

 

March 2016 Medicare Parts C & D Fraud, Waste and Abuse Training– Dated 02/18/16

Summary: Registration is now open for the March 2016 Medicare Parts C & D Fraud, Waste and Abuse Training hosted by CMS Center for Program Integrity. The training will be held March 22-24, 2016 at the Hyatt Regency North Houston Hotel in Houston, Texas. All Part C and D plan sponsors are encouraged to take advantage of this training opportunity. General Session will begin on March 23, 8:30a.m.-5:00p.m. CT and March 24, 9:00a.m.-12:00p.m. CT. 

Action: Informational to PACE plans. 

 

Correction to Attachment: CMS Guidance and Timeline for Contract Year 2017 Contract– Dated 02/19/16

Summary: A corrected version of the Service Area Consolidation Template referenced in the February 18, 2016 HPMS memo, “CMS Guidance and Timeline for Contract Year 2017 Contract Consolidations” has been supplied in an attachment on this memo. 

Action: Informational to PACE plans. Please refer to the memo for the corrected attachment. 

 

Update on Medicare Advantage – Dated 02/19/16

Summary: A conference call was held on February 19th, 2016 at 5:00 PM EST by Sean Cavanaugh, Deputy Administrator of CMS and the Director of the Center for Medicare, to discuss Medicare Advantage and Medicare Part D.  

Action: Informational to PACE plans.  

 

Advance Notice of Methodological Changes for CY 2017 for Medicare Advantage, Part D and 2017 Call Letter– Dated 02/19/16

Summary: A conference call was held on Monday, February 22, 2016 at 2:00 PM ET. Attached to the memo was an “Advance Notice of Methodological Changes for CY 2017 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies and 2017 Draft Call Letter”.      

Action: Informational to PACE plans. For further information please view the attachment provided in the email. 

 

Access to the HPMS Compliance Activity Module –Dated 02/19/16

Summary: All MAO, PDP Sponsors, Section 1876 &1833 Cost Plans, PACE Organizations, and Medicare-Medicaid Plans may now access Notices of Noncompliance, Warning Letters, and Ad-Hoc CAP’s issued since April 2006 in HPMS. Users can access the information through the following path: HPMS Homepage>Monitoring>Compliance Activity and may only access information connected with contracts associated with their User IDs. This modification has been made to promote transparency and allow organizations to better monitor and analyze their own performance.     

Action: Informational to PACE plans.

 

Annual Verification of Parent Organization and Legal Entity Name– Dated 02/19/16

Summary: All current and prospective Medicare Advantage, Prescription Drug Plan, Cost, PACE and Medicare-Medicaid Plan organizations are requested to review the company’s parent organization and legal entity name as listed in HPMS, and to report any necessary corrections by March 17, 2016. Organizations are required to keep that information up-to-date by reporting changes as soon as they occur to CMS. 

Action: Applicable to PACE plans. Please refer to the memo for further information on definition of Parent Organization and notes on Not-For-Profit Organizations. 

 

Part D Enhanced Medication Therapy Management Model Learning Event-March 1, 2016– Dated 02/22/16

Summary: CMS is putting on the fourth Health Plan Innovation Part D Enhanced Medication Therapy Management Model learning event on Tuesday, March 1, 2016 at 1:30-3:00pm EST. CMS will release the proposed Enhanced MTM model encounter data specifications for public comment by Friday, February 26, 2016. Webinar presenters will discuss example Enhanced MTM encounter proposed data elements, and explain the format in which model participants must submit encounter data. 

Action: Informational to PACE plans. Please refer to the email for information on registration. 

 

Reissued-Submission of 2015 Plan Oversight of Agents Enrollment File Data–Dated 02/22/2016

Summary: CMS requires Part C and Part D Sponsors, 1876 Cost Plans, Medicare Savings Accounts, and Provider-Fee-For Service Plans to submit agent/broker-level Plan oversight of Agents Enrollment File data for CY 2015. The reporting deadline for this data is 02/29/2016.  

Action: Informational to PACE plans. PACE organizations are not authorized to use agents/brokers.

 

Coverage Gap Discount Program: March Participating Labeler Code Update –Dated 02/25/16

Summary: CMS will update the list of participating manufacturer labeler codes for the Coverage Gap Discount Program by March 1, 2016. The update includes the following changes:

Added:

  • 20536 Talon Therapeutics
  • 43485 Aprecia Pharmaceuticals, Inc.

The update will be posted to the CMS website. Additions will be identified in bold red. As a reminder the list of labeler codes applies to Part D coverage. 

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.

 

Update- 2016 Call Center Monitoring Webinar for Medicare Advantage Organizations, Prescription Drug Plans, and Medicare-Medicaid Plans–Dated 02/25/16

Summary: The recording of the 2016 Call Center Monitoring Webinar was held on Wednesday, February 3, 2016. Due to audio technical difficulties, the first 15 minutes of audio were not recorded. To review the script used for the first 13 slides please follow the provided link in the email under Downloads. Please review the .zip file entitled “2016 Call Center Monitoring Slides_Script_Questions and Answers for further information on the call.    

Action: Informational to PACE plans.  

 

2016 Data Validation Training for Contractors–Dated 02/25/16

Summary: All Part C and D sponsors are required to undergo an annual validation of the data they provide as Part C and Part D Reporting Requirements. In order to ensure the independence and reliability of the data reported, each sponsor must select a data validation reviewer (contractor) to conduct the audit. CMS has developed a tool to train reviewers on undertaking data validation audits. The 2016 data validation training is now available. There will be four phases in the 2016 data validation process.    

Action: Informational to PACE plans. For further information on the modules that will be covered and information on how to register and access training please refer to the memo.  

 

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.