Here is your bi-weekly CMS update from Pharmastar.
Not rendering correctly? View this email as a web page here.

Pharmastar_CMS_Header

Updated Hospice File Available– Dated 11/04/15

Summary: This is to notify all Medicare Part D plans that CMS has updated the hospice contact list available through HPMS. To access file go to HPMS home page, click Data Extract Facility/Contact Information. The Hospice Information is listed on the first drop-down box. 

Action: Informational to PACE plans. 

 


 

Request for Comment on Medicare-Medicaid Plan Quality Ratings Strategy– Dated 11/06/15

Summary: CMS is seeking comment from MMPs and other stakeholders to inform our development of a star rating system for MMPs established under the Financial Alignment Initiative. Comments should be sent in PDF form to MMCOcapsmodel@cms.hhs.gov by 5 pm, December 21, 2015. Please identify the organization or individual submitting comments in the title of the document. 

Action: Informational to PACE plans. Please review the attached document in the HPMS memo for details involving the vision for the star rating system. 

 


 

2017 Quality Bonus Payment Determinations and Administrative Review Process for Quality Bonus Payments and Rebate Retention Allowances– Dated 11/06/15

Summary: The Affordable Care Act of 2010 amends the Act to require CMS to make quality bonus payments to MA organizations that achieve at least 4 stars in a 5-star quality rating system. This Act also amends the share savings that MA organizations must provide to enrollees as the beneficiary rebate. As a result, in 2012, quality/Star Ratings directly affected the monthly payment amount MAs received from CMS.

Action: Informational to PACE plans.  

 


 

Invitation to Conference Call Regarding Proposed Changes to the CMS-HCC Risk Adjustment Model for Payment Year 2017– Dated 11/06/15

Summary: Join Sean Cavanaugh, Deputy Administrator of CMS and the Director of the Center for Medicare, for a conference call on Tuesday, November 10, 2015 at 5:00p.m. ET. Participant Number: 1-877-267-1577 Conference ID:992 032 652

Action: Informational to PACE plans. 

 


 

Medication Therapy Management: The State of the Art for Standards and Interoperable Data Exchange Webinar– Dated 11/09/15

Summary: Please review the attached memo in this HPMS memo regarding Medication Therapy Management: The State of the Art for Standards and Interoperable Data Exchange webinar scheduled for Wednesday, November 18, 2015.

Action: Not applicable to PACE plans.

 


 

2016 Readiness Checklist for Medicare Advantage Organizations, Prescription Drug Plans, and Cost Plans– Dated 11/09/15

Summary: CMS is reminding organizations of critical Medicare Part C and D requirements for the Annual Election Period and coverage beginning January 1, 2016. A 2016 Readiness Checklist for operational Medicare-Medicaid Plans will be following in a future memo. Organizations should review the checklist carefully and take the necessary measures to fulfill these key requirements for CY 2016.

Action: Informational to PACE plans.

 


 

User Group Call-Good Cause Process and Operational Changes– Dated 11/12/15

Summary: CMS Medicare Enrollment and Appeals Group, Division of Enrollment and Eligibility Policy, will be hosting a Plan User Group Call on Wednesday, November 18, 2015 from 3:30-5:00 PM EST. Topic of the call is the Good Cause policy and related operational changes.

Action: Not applicable to PACE plans. To register for the call and obtain dial in information, including presentation materials, please visit http://www.mscginc.com/registration/.

 


 

Contract Year 2016 Medicare Requirements Readiness Checklist for Medicare-Medicaid Plans– Dated 11/12/15

Summary: CMS reminds organizations of critical Medicare requirements for the Annual Election Period and coverage beginning January 1, 2016. The CY 2016 Readiness Checklist is provided in this memo. Organizations should review the checklist carefully and take the necessary measures to fulfill these key requirements for CY 2016.

Action: Informational to PACE plans. As recommended by NPA, Pharmastar will reference the PACE Part D application. Pharmastar will provide our plans with a list of all the applicable areas we will be responsible for.

 


 

Request for Comments: Enhancements to the Star Ratings for 2017 and Beyond (Due by December 10, 2015 at 5pm ET)– Dated 11/12/15

Summary: This document proposes methodology changes for the 2017 Star Ratings and display measures for MA and PDPs. It also provides potential changes for the Star Ratings and display measures for 2018 and beyond. This Advanced Notice allows MA Organizations, PDP sponsors, Advocates, and other stakeholders the opportunity to provide comments prior to the draft Call Letter. 

Action: Informational to PACE plans. For further information please read through the memo. 

 


 

Independent Auditor Validation Process for Medicare Advantage and Prescription Drug Plan Program Audits– Dated 11/12/15

Summary: On February 12, 2015, final rule changes were made and CMS now has the authority to require a sponsoring organization to hire an Independent Auditor (IA) to validate if the deficiencies that were found during CMS full or partial program audits have been corrected. Based on 2015 program results and going forward, CMS will inform the Sponsor in the final audit report whether an IA is required.  

Action: Informational to PACE plans.

 


 

Medicare A/B Payment to Medicare-Medicaid Plans Participating in the Financial Alignment Initiative for Contract Year 2016– Dated 11/12/15

Summary: For CY 2016, payments to MMPs will continue to be based on the same CMS-HCC risk adjustment model as used in MA. However, Medicare A/B payment rates will be adjusted to better align MMP payments with FFS costs for full benefit dual eligible beneficiaries. Updates will apply for all twelve months of CY 2016. 

Action: Informational to PACE plans. 

 


 

Request for Comments on the Draft Medicare-Medicaid Capitated Financial Alignment Model Quality Withhold Technical Notes for DY 2 and 3– Dated 11/12/15

Summary: Comments are being solicited on the Medicare-Medicaid Capitated Financial Alignment Model Quality Withhold Technical Notes for Demonstration Years 2 and 3. Please view the a documents within the HPMS memo for further information on the methodology associated with the payments for MMPs.

Action: Not Applicable to PACE plans. 

 


 

Provider Directory Requirements-Update– Dated 11/13/15

Summary: The response provided on the 2016 Call Letter and Medicare Marketing Guidelines regarding monthly communications with the contracted providers and subsequent online directory updates has drawn attention to the undue burden this would put on the providers. Thus, effective immediately, this section was updated to reflect that MAOs and MMPs should proactively conduct at least quarterly communications with contracted providers to ensure that the required information in the directory is accurate.

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

 


 

New Mailbox and Portal for Medicare Advantage policy questions– Dated 11/17/15

Summary: The launch of the new CMS mailbox and portal for Medicare Advantage policy questions is now available at https://dpap.lmi.org . This will be the single point of entry for asking MA policy questions, access to resources and frequently asked questions, as well as information about other CMS mailboxes and email addresses that may be helpful. Please review the resources and FAQs provided before submitting your questions. 

Action: Informational to PACE plans. This new mailbox will replace the existing Quality mailbox (MAQuality@cms.hhs.gov) and EOB mailbox (PartCEOB@cms.hhs.gov). 

 


 

Clarification of Fiscal Soundness Requirements– Dated 11/17/15

Summary: Medicare Advantage Organizations, Medicare-Medicaid Plans, PACE plans, 1876 Cost Plans, and Prescription Drug Plans that contract with CMS are required to satisfy all applicable state licensure, state and CMS financial requirements, and to submit their independently audited financial statements to CMS on an annual basis. 

Action: Applicable to PACE plans. In March of each year CMS announces the release of the current Year’s Fiscal Soundness Module and Fiscal Soundness Requirements.

 


 

2016 Medicare CAHPS Survey– Dated 11/18/15

Summary: CMS would like to remind MAOs, 1876 Cost Contracts, and Part D sponsors about the 2016 Medicare CAHPS Survey, the procedures for requesting additional sample, and the rules regarding the number of supplemental items. CMS also provided survey results to contracts regarding Vendors, Authorizing a Vendor, Oversampling, Supplemental Items, Administering the Survey in Other Languages, and Reports. 

Action: Informational to PACE plans. Please review the memo for full details on the survey results. 

 


 

December Actuarial User Group Call and Release of CY 2017 BPT Updates– Dated 11/18/15

Summary: CMS Office of Actuary will be hosting an actuarial user group call on Thursday, December 3, 2015, 11:00-12:00 pm ET. The purpose of the call is to cover CY 2016 bidding process, potential changes to the CY 2017 Bid Pricing Tools and instructions, and to respond to questions that industry actuaries may have on CY 2017 bids. 

Action: Informational to PACE plans. Participant Dial-In number is 800-603-1774 and the Conference ID Number is 74546438. The Conference ID number will be requested per the operator in order to join the call. 

 


 

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.