Not rendering correctly? View this email as a web page here.


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

Important Upcoming Deadlines

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


Medicare Part C and Part D Data Validation – 60 day Comment Period –Dated 7/5/2016

Summary: CMS is looking for comments on the Medicare Part C and Part D Data Validation of Reporting Requirements data for the 2017 and 2018 collection periods.  Comments must be received by August 29, 2016.

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


Medicare Part D Fraud: Billing for Services not Rendered, Misrepresenting Services and Products, and Drug Shortages –Dated 7/5/2016

Summary: The provider named in the memo allegedly submitted fraudulent claims under Medicare Part D from January 1, 2015 through June 1, 2016.

Action: Informational to PACE.  Pharmastar has performed a targeted audit and found no utilization of the provider for any of our client plans.


Payment Year (PY) 2010 Overpayment Recovery –Dated 7/6/2016

Summary: CMS announced for this year’s PY 2010 risk score rerun, the deadline to submit all PY 2010 deletions to the Risk Adjustment Processing System will be August 5, 2016.  The sweep will occur on August 5, 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.


2017 Draft Program Audit Protocols Location –Dated 7/8/2016

Summary: CMS announced the location of the 2017 draft Program Audit Protocols for public comment.  The link is provided in the email.  Any comments and feedback can be sent by August 12, 2016.

Action: Informational to PACE.  


Encounter Data Software Releases –Dated 7/8/2016

Summary: CMS released information on the Encounter Data Processing System changes for the following and may require Plan action:

  • Changes to Encounter Data MAO-004 Reports
  • Changes to Error Codes Reported on MAO-002 Reports

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


Invitation to Provide Feedback on the Contract Year 2017 Bid Submission –Dated 7/11/2016

Summary: CMS is seeking feedback on the Contract Year (CY) 2017 bid submission process in HPMS.  The feedback period will take place from July 11, 2016 – July 22, 2016.  The link to providing feedback is provided.  Access to HPMS is not required.

Action: Informational to PACE.  PACE plans interested in providing feedback, refer to memo for complete details.


Overview of the Medicare Part D Coordination of Benefits (COB) Process for PACE Organizations –Dated 7/12/2016

Summary: CMS is reminding PACE organizations the responsibilities for Coordination of Benefits under Medicare Part D.  PACE organizations are encouraged to review the Chapter 14 of the Medicare Prescription Drug Benefit Manual for the complete Part D COB requirements.   In addition, CMS made modifications to the COB process on the following when participants in PACE transfers to another Part D plan:

  • Transferring TrOOP-related data
  • Beneficiary Notice Requirements

Action: Applicable to PACE.  Refer to memo for complete details. Pharmastar does provide a PACE-specific notice to plans which includes the participant’s TrOOP balance and gross covered drug costs for all participants who disenrolled.  Plans are responsible for sending out the notice.  Contact your Client Support Specialist, if you have any questions.


Second Round of HPMS Crosswalk Exceptions for Contract Year (CY) 2017 –Dated 7/13/2016

Summary: CMS announced the second opportunity for organizations to review their current plan crosswalk relationships from CY 2016 to CY 2017, as this is the last time plans can request modifications to their HPMS plan crosswalks.  Organizations can submit the crosswalk exception requests through HPMS from July 13 through July 15, 2016.

Action: Informational to PACE as PACE is not required to renew their contracts on a year to year basis.


Contract Year 2017 Agent and Broker Compensation Submission and Attesting Requirements –Dated 7/13/2016

Summary: CMS reminds plans that they must comply with CMS’s agent and broker compensation submission and attestation requirements.  All plans must indicate if they are using agents and brokers in contract year 2017. The attestation must be submitted by July 29, 2016.

Action: Informational to PACE as PACE is not authorized to utilize agents and/or brokers.

Follow Pharmastar on Twitter!

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.


A real person always answers the phone at Pharmastar.
Sometimes the most important questions happen after normal business office hours. That’s why you can always talk to one of our pharmacy technicians 24/7/365 simply by calling us at (888) 298-7770.