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

Request for Timely Enrollment Updates

Due to the Fourth of July holiday, Pharmastar is asking plan Enrollment Departments to send us any member enrollment/disenrollment and changes, if it is available, as timely as possible.  Please forward this information to your organization’s Enrollment Department along with the Pharmastar email address: pstar@pharmastarpbm.com, as any enrollment information received after 4:00p.m CST on July 1st will not be loaded until Tuesday, July 5th

Pharmastar Office Closed for the Fourth of July Holiday

The Pharmastar Administrative office will be closed on Monday, July 4, 2016.  As always, the Pharmastar Pharmacy Help Desk will be available for your needs throughout the coming holiday at 888.298.7770.

 

Important Upcoming Deadlines

2015 Final PDE Submission               June 29, 2016 at 11:59 PM ET

2015 DIR Submission                         June 30, 2016 at 11:59 PM PT

2011-2014 DIR Re-submission          July 31, 2016 at 11:59 PM PT

 

 

2017 Transition Letter –Dated 6/3/2016

Summary: CMS removed the 2017 transition letter which was posted on the CMS website before being finalized.  A finalized 2017 transition letter will be issued as soon as possible to reflect changes revised in the Chapter 6 Medicare Prescription Drug Benefit Manual.

Action: Informational to PACE plans. Applies only to PACE plans that utilize a formulary.

 

Plan Benefit Package Clarification for Employer Plans –Dated 6/5/2016

Summary: CMS released information to address a conflict between CMS guidance and a Plan Benefit Package (PBP) data entry question related to employer plans.

Action: Informational to PACE plans as this memo pertains to Employer Plans only.

 

REMINDER: Process for Requesting an HPMS Crosswalk Exception for Contract year (CY) 2017 –Dated 6/6/2016

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.  CMS would like to remind organizations that the ability to request a crosswalk exception for CY 2017 opens June 7, 2016 to June 10, 2016.

Action: Informational to PACE as PACE plans are not required to renew their contracts on a year to year basis as Medicare Advantage plans.

 

Reporting and Returning Risk Adjustment Related Overpayments –Remedy Tickets on RAPS Files –Dated 6/7/2016

Summary: CMS announced starting August 14, 2016, CMS is eliminating the requirement to include a Remedy ticket on the RAPS file when submitting deleted diagnoses after the risk adjustment deadline.  As a result, organizations will be able to submit the file the same day the overpayment is reported to the MAPD help desk.

Action: Applicable to PACE.  Refer to the memo for further details.

 

SAVE THE DATE – New HPMS Errata Submission Training –Dated 6/7/2016

Summary: CMS announced a training opportunity on the changes to the Errata submission process in HPMS.  The training will be held on September 26, 2016.  Further notices on the training will be released at a later date.

Action: Informational to PACE.

 

CORRECTION: Process for Requesting an HPMS Crosswalk Exception for Contract Year (CY) 2017 –Dated 6/8/2016

Summary: CMS is addressing an error that was stated in a previous email in regards to the Process for Requesting an HPMS Crosswalk Exception for CY 2017.  CMS no longer requires Medicaid subsets for D-SNPs and is no longer a valid reason for submitting a crosswalk exception.  The corrected version of the email is attached.

Action: Informational to PACE.

 

Final Reminder: Payment Year 2015 Risk Adjustment Attestation –Dated 6/8/2016

Summary: CMS released a final reminder to all plans that the deadline for submitting the required risk adjustment attestations for payment year 2015 is June 10, 2016 by 11:59 p.m. ET.  All plans are required to submit an “Attestation of Risk Adjustment Data” to certify that 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.  

Action: Applicable to PACE plans.  Refer to the memo for further details.

 

Guidance for Submitting State Medicaid Agency Contracts –Dated 6/8/2016

Summary: CMS released guidance to Medicare Advantage Organizations seeking to offer a Dual Eligible Special Needs Plan in Contract Year 2017 on contract requirements and submission deadlines.

Action: Informational to PACE.

 

Spring 2016 Past Performance Results Available in HPMS –Dated 6/9/2016

Summary: CMS has the results of organization performance for the period of January 2015 through February 2016 available in HPMS.  The analysis was conducted in accordance with the past performance methodology published in HPMS.  Users may view results associated with their organizations by going to HPMS and following the pathway provided in the email.  

Action: Informational to PACE.

 

2016 Part D Reporting Requirements and Technical Specifications –Dated 6/10/2016

Summary: CMS made corrections to the CY 2016 Part D Reporting Requirements and Technical Specifications. All corrections are noted in the email.  Revised documents are posted on the HPMS Plan Reporting site and on the external CMS website.

Action: Informational to PACE as PACE is waived of the Part D reporting requirements.

 

2017 Medicare Marketing Guidelines –Dated 6/10/2016

Summary: CMS announced the release of the 2017 Medicare Marketing Guidelines.  There have been several notable revisions and are shown in red text. The summary of changes to the 2017 Medicare Marketing Guidelines is provided.

Action: Informational to PACE as PACE does not follow the MAPD Marketing guideline requirements.

 

2017 CMS-HCC Risk Adjustment Model Implementation –Dated 6/10/2016

Summary: CMS revised the CMS-HCC model used to pay for beneficiaries enrolled in Medicare Advantage plans and certain demonstrations.  CMS is providing information on how it is currently working to make system changes for payments beginning in January 2017.  

Action: Informational to PACE.

 

Updates to the HPMS Marketing Module and Marketing Codes for Medicare-Medicaid Plans –Dated 6/12/2016

Summary: CMS summarized the Medicare-Medicaid Plan-specific updates for the HPMS Marketing Module which includes edits to existing marketing codes and addition to new marketing codes.

Action: Informational to PACE as PACE does not follow the MAPD Marketing guideline requirements.

 

For Comments: MMP Quality Rating and Performance Data Strategy Update –Dated 6/15/2016

Summary: CMS is seeking comments on a proposed list of quality measures for public reporting of Medicare-Medicaid Plans (MMPs) performance for fall 2016. Comments can be sent to the provided email address by July 1, 2016.  Also attached is a document with public comments on the longer term vision for an MMP star rating system.

Action: Informational to PACE.

 

Update to the Medicare Individual Providers List –Dated 6/15/2016

Summary: CMS included two new fields to the Medicare Individual Providers list to address retroactive records. The Medicare Individual Providers list is used to identify which providers are enrolled once the Part D Prescriber Enrollment requirement is enforced beginning February 1, 2017.  

Action: The Part D Prescriber Enrollment requirement is applicable to PACE. Refer to the attachment for additional information on the new fields. 

 

2017 Draft Program Audit Protocols Now Posted in the Federal Register –Dated 6/16/2016

Summary: CMS announced the posting of the 2017 Draft Program Audit Protocols for public comment in the Federal Register.  Plans are highly encouraged to closely review the draft protocols and provide comments and feedback. All comments and feedback are due by August 12, 2016.

Action: Informational to PACE. 

 

Part D Summary DIR Report and Detailed 2015 DIR Report – Submission Reminder –Dated 6/16/2016

Summary: CMS reminds plans to submit their 2015 DIR reports by the June 30th deadline.  Failure to successfully submit the DIR data by the deadline may result in compliance actions.  

Action: Applicable to PACE plans.  Refer to the memo for complete details on the DIR requirements.  Pharmastar will receive the initial DIR reporting in the coming week and will format per CMS requirements before sending them on to the plan sponsors.  Your Client Support Specialist (CSS) will communicate with previous years’ DIR contact(s) when the reports are available.  Please notify your CSS of any applicable changes.

 

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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.

 

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