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

 

CY2017 Actuarial Bidder Training –Dated 4/8/2016

Summary: CMS announced the CY 2017 Actuarial Bid Training to be on April 8, 2016.  The training will consist of ten sessions to assist actuaries in preparing or certifying the CY 2017 bids.  The training can be independently viewed at any time after the posting date as a webcast, and the presentation slides can be downloaded and printed from the website.

Action: Informational to PACE.  No registration is required to access the online training materials. Refer to the memo for additional information.

 

Applicability of CY 2017 Final Call Letter Provisions to Medicare-Medicaid Plans –Dated 4/8/2016

Summary: CMS provided additional guidance regarding the Medicare Medicaid Plans (MMP) provisions of the CY 2017 Final Call Letter.  

Action: Informational to PACE, as the memo applies to MMP only.

 

Release of the 2017 Plan Benefit Package (PBP) Training –Dated 4/8/2016

Summary: CMS announced the release of the 2017 Plan Benefit Package (PBP) hands-on training presentation which provides information about the relationship between the PBP and Health Plan Management System, key software features in the PBP, demonstrations of each PBP section, and a review of the software changes made for Contract Year 2017.

Action: Informational to PACE plans.  For individuals interested in the training, refer to the memo on how to register.

 

Release of the 2017 Plan Benefit Package and Bid Pricing Tool Software and Related Technical Bidding Guidance for Employer/Union-Only Group Waiver Plans –Dated 4/8/2016

Summary: CMS announced the release of Contract Year 2017 Plan Benefit Package (PBP), Bid Pricing Tool (BPT), and plan creation functionality in the Health Plan Management System (HPMS). 

Action: Informational to PACE plans.  Refer to memo for information on how to access the information in HPMS. 

 

Correction –CY 2017 Medication Therapy Management Program Guidance and Submission Instructions – Dated 4/8/2016

Summary: CMS previously released guidance on Contract Year 2017 Medication Therapy Management (MTM) programs.  A date was incorrect on the previous memo released.  The date has been corrected to the initial submission window end date.

Action: For PACE plans with MTM programs; refer to the memo for complete details.

 

Reporting of National Medicare Advantage Contract-Level Quality Scores by Race and Ethnicity –Dated 4/8/2016

Summary: CMS announced it will release data detailing health care experiences and quality of care received by Medicare beneficiaries by racial and ethnic group.  The data are based on analysis of two sources of information: HEDIS and CAHPS. The reports will be available on April 19, 2016 and annually on the CMS OMH website.  The data can be used to improve performance for:

  • Targeting quality improvement activities and resources
  • Monitoring health and drug plan performance

Advancing the development of quality improvement interventions and strategies

Action: Informational to PACE as PACE is waived of the CAHPS survey and Part D Reporting requirement. 

 

Updates to Prescription Drug Event Edit 870 –Dated 4/11/2016

Summary: CMS modified edit 870 by updating the gap discount calculation logic for gap eligible claims submitted by a Calendar Year Employer Group Waiver Plan (EGWP) on or after January 1, 2014. Edit 870 logic will now include any TrOOP accumulated in the deductible and/or initial coverage phase for the straddle claim when determining the gap discount amount applying the defined standard benefit.  Edit 870 in error for PDEs with dates of service on or after January 1, 2014 should be resubmitted after April 17, 2016.

Action: Informational to PACE as the edit may affect participant True Out-of-Pocket calculation.  Pharmastar will generate a report for all edit 870 with dates of service on or after January 1, 2014 and notify your plan if there are PDEs that need to be resubmitted.

 

Release of the Service Area Reduction (SAR) Module in the Health Plan Management System (HPMS) –Dated 4/12/2016

Summary: CMS announced the release of a new Service Area Reduction (SAR) module in HPMS to allow plan users to request a SAR directly in HPMS for CMS’ review and approval.  All Contract Year 2017 SAR requests are to be received in HPMS no later than June 6, 2016.

Action: Applicable to PACE.  Refer to memo for additional information.

 

Payment Year 2013 Payment Data Correction and Risk Adjustment Data Validation –Dated 4/12/2016

Summary: CMS is preparing the Payment Year (PY) 2013 Contract-Level Risk Adjustment Data Validation (RADV) audit.  Before CMS pulls samples for the audit, Medicare Advantage (MA) Organizations have an opportunity to delete diagnosis data previously submitted to the Risk Adjustment Processing System (RAPS).  MA Organizations selected for the audit will not be able to submit any PY 2013 data into RAPS after May 5, 2016.  MA Organizations not selected for the audit can continue to submit diagnosis deletions after May 5, 2016. All deletions received by the deadline will be included in the risk score rerun and subsequent overpayment recovery.  

Action: Informational to PACE.  Refer to memo for additional information.

 

Continuation of the Prescription Drug Event (PDE) Report and PDE Analysis Reporting Initiatives for the 2016 Benefit Year –Dated 4/12/2016

Summary: CMS announced the continuation of two reporting initiatives for the 2016 benefit year that supports CMS’s efforts to improve the accuracy of sponsors’ PDE data: the PDE Reports and PDE Analysis initiatives.  The reports are facilitated via secure websites by Acumen LLC.  An overview of the reports and actions excepted from participating sponsors is provided.

Action: Applicable to PACE.  If your plan does not have access to the websites for the reports, refer to the memo for instructions on how to gain access.  New user requests and current user verification are due two weeks from the date of the memo.

 

CY2017 PDP Contract Consolidation Requests –Dated 4/12/2016

Summary: CMS released guidance for Stand-Alone Prescription Drug Plan sponsors seeking to consolidate PDP contracts for CY 2017.

Action: Informational to PACE as PACE plans are not stand-alone PDP.

 

Participation Indicator for the State Health Insurance Assistance Program (SHIP) UniqueID Database –Dated 4/12/2016

Summary: The State Health Insurance Assistance Program UniqueID system has been utilized by many plans.  The Unique ID system allows SHIP counselors to obtain information from CMS and many plans to assist beneficiaries with claims-related issues and concerns.  CMS would like MA organizations and Part D sponsors that participate in the SHIP UniqueID program and accept SHIP UniqueID to complete a question in HPMS by April 29, 2016.

Action: Informational to PACE.  

 

Reminder regarding Contract Year 2017 Medicare Advantage Applications and Service Area Expansion Requests –Dated 4/13/2016

Summary: CMS reminds all Medicare Advantage applicants that CMS will not approve initial or service area expansion applications if network deficiencies are found in any counties in Contract Year 2017 service area.  Applicants will be notified of any application deficiencies and how to cure these deficiencies in the notice of intent to deny which will be out on April 18, 2016. Information on how to remove a failing county from their application should complete the steps provided.

Action: Not applicable to PACE as PACE utilizes its own application and service area expansion process and is not required to comply with CMS network adequacy standards.

 

Request for Part D Coverage Gap Discount TPA Contact Information –Dated 4/14/2016

Summary: CMS released information on two new CGDP TPA contact roles in HPMS.  Plans are asked to update their company’s contact information in the HPMS Contract Management module before April 25, 2016.

Action: Informational to PACE as PACE participants are not eligible to participate in the Coverage Gap Discount Program.  

 

Contract Year 2017 Medicare Advantage Bid Review and Operations Guidance –Dated 4/14/2016

Summary: The following information is provided by CMS for Medicare Advantage Organizations as they prepare Contract Year 2017 bids for CMS review:

  • Information about several specific changes to the Plan Benefit Package software for CY 2017;
  • Clarification of existing benefits policies;

Detailed operational guidance to support plans in their bid development

Action: Informational to PACE.

 

Summary of Benefits Guidance for Contract Year 2017 –Dated 4/15/2016

Summary: CMS released guidance to prepare Contract Year 2017 Summary of Benefits (SB) in accordance with CMS requirements.  Plans will no longer generate the SB in HPMS as Plans must now develop their own SB from their approved bid and from the guidance provided.  A sample SB document is attached for reference.

Action: Informational to PACE.

 

Total Beneficiary Cost (TBC) Data for CY 2017 Bid Preparation –Dated 4/18/2016

Summary: CMS announced the plan-specific adjustment amounts that Medicare Advantage organizations must use to determine their plans’ compliance with CMS’ TBC requirement.  Plans must calculate the unadjusted change in TBC and use the formulas and adjustment amounts provided on HPMS to ensure their plan-specific adjusted change satisfies TBC requirements.

Action: Informational to PACE.

 

Registration Closing for CMS’ 2016 Medicare Advantage & Prescription Drug Plan Spring Conference & Webcast (May 5, 2016) – Dated 4/20/2016

Summary: CMS announced that the in-person registration for the spring conference & webcast held on May 5, 2016 will close on April 22nd.  However, the webcast registration will remain open.  Every attendee interested in attending in the event must register separately.

Action: Informational to PACE.  For individuals interested in attending, refer to the attachment for additional information.

 

Incoming File from CMS: beneficiary-level file to support 2017 Part D bids – Dated 4/20/2016

Summary: CMS is releasing a new beneficiary-level file to help plans with their 2017 Part D bids.  Potential action may be needed from plans to receive the file.

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

 

Incoming File from CMS: beneficiary-level file to support 2017 Part C bids – Dated 4/20/2016

Summary: CMS is releasing a new beneficiary-level file to help plans with their 2017 Part C bids.  Potential action may be needed from plans to receive the file.

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

 

Deadline for Submitting Risk Adjustment Data for Use in Risk Score Calculation Runs for Payment Years 2016, 2017, and 2018 –Dated 4/20/2016

Summary: CMS announced the upcoming deadlines to submit risk adjustment data for use in calculating risk scores for Payment Years 2016, 2017, and 2018.  All risk adjustment data that will be included in the listed risk score runs need to be submitted by the listed “Deadline for Submission”.

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

 

Job Aids Replace the Common Conditions, Best Practice Audit Memos –Dated 4/20/2016

Summary: As most common conditions found during audits are communicated through CMS Common Conditions Best Practice memos, CMS created job aids as a quick reference tool for plans to use in their day-to-day work in Coverage Determination, Appeals and Grievances and Organization Determination, Appeals and Grievances audits. 

Action: Informational to PACE.  Refer to memo and attachments for additional information.

 

**Updated file layout** Incoming File from CMS: beneficiary-level file to support 2017 Part C bids –Dated 4/21/2016

Summary: CMS released an updated file layout for the new beneficiary-level file to help plans with their 2017 Part C bids.  As mentioned previously, potential action may be needed from plans to receive the file.

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

 

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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.