Learn more about CMS Updates that may impact your PACE Plan. Featured Memo: Payment Year 2015 Risk Adjustment Attestation –Dated 5/10/2016
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Learn more about CMS Updates that may impact your PACE Plan.

Release of the Contract year (CY) 2017 Bid Upload Functionality in HPMS –Dated 5/6/2016

Summary: CMS announced the release of the Contract Year 2017 bid upload functionality in the HPMS Bid Submission module.  To access the CY 2017 bid upload functionality, the navigation path in HPMS is provided.  A listing of the upload requirements is provided with further details on how to upload each requirement.

Action: Informational to PACE.  Refer to memo for further details.

 

Contract Year 2016 Monitoring Parts C & D Reporting Website Access –Dated 5/6/2016

Summary: The continuation of the Monitoring Parts C & D Reporting which is facilitated via the Acumen website will continue for the 2016 benefit year. An overview of the report is provided and the actions expected from participating plans are included in the memo.

Action: Not applicable to PACE as PACE is waived of the Part C and D reporting requirements.

 

Release of the Licensure Module for Stand-alone Prescription Drug Plan Sponsors –Dated 5/10/2016

Summary: CMS announced the new Licensure Module in HPMS for Prescription Drug Plan (PDP) sponsors.  The module will be released on May 11, 2016.  The module allows PDPs to upload a copy of its current state license/certificate of authority when the copy on file with CMS has expired.  

Action: Informational to PACE as PACE plans are not Stand-alone PDPs.

 

Close-Out Letter for Organizations and Sponsors that Non-Renew a Contract effective on or before January 1, 2017 –Dated 5/10/2016

Summary: CMS released the post-contract non-renewal requirements.  Contracts that are non-renewing effective or before January 1, 2017 should follow the applicable instructions provided for your organization type.  

Action: Informational to PACE as PACE plans are not required to renew their contract on a year to year basis as mainstream MA plans are.

 

ACTION: Payment Year 2015 Risk Adjustment Attestation –Dated 5/10/2016

Summary: CMS requires plan sponsors to submit a risk adjustment attestation annually to certify that the information provided for the purposes of risk adjustment are accurate, complete, and truthful, and acknowledge that the information will be used for the purposes of obtaining federal reimbursement.  The attestation for payment year 2015 is now available on HPMS and must be submitted by Friday, June 10, 2016 by 11:59pm PDT.  

Action: Applicable to PACE.  Refer to memo for further directions and a copy of the attestation.

 

Issuance of Contract Year 2017 Model Materials –Dated 5/10/2016

Summary: CMS announced the release of the Contract Year 2017 Model Materials.  Plans must ensure that their CY 2017 documents are compliant with CMS requirements.  All models and standardized documents can be located in the link provided.  

Action: Informational to PACE as PACE does not follow the MAPD marketing guidelines.

 

Medicare-Medicaid Plan Member Material Model Updates for Contract Year 2017 –Dated 5/11/2016

Summary: This month, the Medicare-Medicaid Coordination Office will begin to issue state-specific Medicare-Medicaid Plan (MMP) member materials for us in Contract Year (CY) 2017.  Attached to the memo are the CY 2017 national model templates for the MMP ANOC and Member Handbook Chapter 9. 

Action: Informational to PACE as PACE does not follow the MAPD marketing guidelines.

 

Medicare Part C Plan Reporting Requirements Technical Specifications Document Contract Year 2016 Effective Date: January 1, 2016 Version Date 4/22/16 –Dated 5/13/2016

Summary: CMS announced the release of the Medicare Part C Plan Reporting Requirements Technical Specifications Document.  A link to the document is provided in the email.

Action: Informational to PACE as PACE plans are waived of the Part C reporting requirements.

 

2015 Medicare Health Outcomes Survey (HOS) Baseline and Medicare HOS-Modified (HOS-M) Reports –Dated 5/16/2016

Summary:

CMS released the following reports and data for participating Medicare managed care plans:

  • 2015 Medicare HOS Cohort 18 Baseline Report
  • 2015 Medicare HOS-Modified Report

Action: Informational to PACE plans.  For plans who participated in the 2015 Cohort 18 Baseline or 2015 HOS-M, refer to the memo for further details on the reports.

 

Payment Year (PY) 2014 Overpayment Recovery –Dated 5/17/2016

Summary: CMS announced for this year’s PY 2014 risk score rerun, the deadline to submit all PY 2014 deletions to the Risk Adjustment Processing System will be June 10, 2016.  The sweep will occur on June 10, and all deletions received by the deadline will be included in the risk score rerun and subsequent overpayment recovery.  As required by the overpayment regulation, all MA organizations are required to report and return overpayments.

Action: Informational to PACE.  Refer to memo for further details.

 

Agenda Update (New Session Added) for CMS’ 2016 Medicare Advantage and Prescription Drug Plan Audit & Enforcement Conference & Webcast (June 16, 2016) –Dated 5/17/2016

Summary: CMS released an update to the CMS’ Medicare Advantage and Prescription Drug Plan Audit & Enforcement Conference & Webcast.  A new session topic has been added to the event on Section 504; Equal Access for all Beneficiaries.  All interested individuals can register for the event which will take place on June 16, 2016.

Action: Informational to PACE.  For individuals who are interested, refer to the attachment on how to register.  

 

Process for Requesting an HPMS Crosswalk Exception for Contract Year (CY) 2017 –Dated 5/18/2016

Summary: Guidance is provided on the HPMS crosswalk exceptions process that is available to Medicare Advantage Organizations (MAO) and Prescription Drug Plan (PDP) sponsors for CY 2016.  The exceptions were listed in the April 4, 2016 announcement. Organizations will be able to submit crosswalk exception requests through HPMS from   Tuesday, June 4, 2016 through Friday June 10, 2016 at 5:00 p.m. ET.

Action: Informational to PACE plans.  Refer to memo for further details regarding the exceptions and additional guidance on submitting exceptions.

 

Coverage Gap Discount Reconciliation Reopening for Benefit Year 2014 –Dated 5/19/2016

Summary: CMS has corrected the allocation of sequestration amounts to the Coverage Gap Discount Subside Amounts and will perform a reopening for contracts with Employer Group Waiver Plans impacted by this issue.  

Action: Informational to PACE as the Coverage Gap Discount Program does not apply to PACE plans.  

 

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CY 2017 Transition Attestations

CMS released an email on May 12, 2016 and advised Medicare Compliance Officers and Formulary Contacts on the CY 2017 Transition Attestations. Per CMS guidance, the transition attestations only apply to PACE plans with formularies. Plans with formularies on file with CMS must complete the attestations.  Any questions on the attestations should be sent to CMS at PartDtransition@cms.hhs.gov.

 

Pharmastar Office Closed for Memorial Day

The Pharmastar Administrative office will be closed on Memorial Day.  As always, the Pharmastar Pharmacy Help Desk will be available for your needs throughout the coming holiday at 888.298.7770.

 

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.