Featured Update: June 2016 Release Pharmacy Risk Assessment – Feedback Requested
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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

 

Clarification of Data Elements 13.1 and 13.2 for Reporting Section #13 Special Needs Plans (SNPs) Care Management as contained in Medicare Part C Plan Reporting Requirements Technical –Dated 6/20/2016

Summary: CMS revised the Medicare Part C Plan Reporting Requirements Technical Specifications Document Contract Year 2016. The document with the revisions will be available soon at the link provided.  

Action: Not applicable to PACE as the email is specific to Special Needs Plans.

 

In-person Registration Closing for CMS’ 2016 Programs All-Inclusive Care for the Elderly (PACE) Conference & Webcast (July 7-8, 2016) –Dated 6/22/2016

Summary: CMS announced the closing date for the 2016 Programs All-Inclusive Care for the Elderly (PACE) conference and webcast in-person registration to be on Friday, June 24th.  Information on the conference, along with registration information is provided in the attachments.

Action: Applicable to PACE.  For all individuals interested, refer to the attachments for additional information on how to register.

 

HPMS FAQs – Updated –Dated 6/24/2016

Summary: CMS updated the Frequently Asked Questions (FAQs) module on HPMS.  Individuals with questions are encouraged to utilize the tool. 

Action: Informational to PACE.

 

Updated URL for Medicare Advantage/Part D Contract and Enrollment Data on www.cms.gov –Dated 6/24/2016

Summary: CMS implemented a new URL to simplify the process for accessing the Medicare Advantage/Part D Contract and Enrollment Data on cms.gov.  All users must use the new URL as the old URL will no longer work after July 1, 2016.

Action: Informational to PACE.  Refer to memo for additional information.  The new URL is http://go.cms.gov/mapddata

 

Quality Assurance Checks for 2017 Data Submitted for Posting on the Medicare Plan Finder Tool –Dated 6/29/2016

Summary: CMS updated the contract year (CY) 2017 guidance and schedule for the submission of pricing and pharmacy data for posting on the Medicare Plan Finder (MPF).  Information on the QA analysis process and an updated listing of the targeted QA checks is provided.

Action: Informational to PACE as PACE plans are only required to provide contact information for inclusion to the MPF website.  PACE does not supply any pricing data for any services to the MPF website. 

 

Sponsor’s Access to the Medicare Plan Finder (MPF) Communications Website –Dated 6/28/2016

Summary: CMS released information on the user authorization process for the Medicare Plan Finder (MPF) Communications Web Portal and the new process on obtaining detailed files related to MPF Price Accuracy Star Rating Measure.

Action: Informational to PACE.  

 

Medicare Advantage/Prescription Drug System (MARx) July 2016 Payment –INFORMATION –Dated 6/29/2016

Summary: This memo provides information related to the July payment:

  • Final 2015 Risk Adjustment Reconciliation
  • Late Enrollment Penalty (LEP) Cleanups
  • Health Information Technology for Economic & Clinical Health Act (HITECH) Bonus Payments for 2015
  • Medical Loss Ratio (MLR) Remittances for 2014

Action: Informational to PACE.  Refer to memo for applicable items for your plan.

 

Announcement of the August 2016 Software Release –Dated 6/29/2016

Summary: CMS released detailed information regarding the planned release of systems changes scheduled for August 2016.  The changes are as follows and may require Plan action:

  • Report Changes-Plan Payment and Monthly Membership Summary Reports
  • Center for Medicare and Medicaid Innovation Division of Health Plan Innovation Models
  • New Enrollment Source Code and New Election Type Code for Rollover Processing
  • Elimination of Overpayment Edits

Action: Applicable to PACE.  Refer the memo for complete details and additional information on the changes.

 

Update to Chapter 14 of the Medicare Managed Care Manual –Dated 6/29/2016

Summary: CMS announces the availability of the updated Chapter 14 “Contract Determinations and Appeals of the Medicare Managed Care Manual”.  The updated manual is available at the link provided in the email.

Action: Informational to PACE.

 

June 2016 Release Pharmacy Risk Assessment – Feedback Requested –Dated 6/30/2016

Summary: The Risk Assessment for June 2016 has been completed by CMS in collaboration with National Benefit Integrity Medicare Drug Integrity Contactor.  CMS provided a list of retail pharmacies categorized with a high risk assessment and expects plans to use the information provided to make further determinations about potential fraud, waste and abuse to the pharmacies that have been identified for your plan.  CMS expects plans to take the actions mentioned in the memo. Any feedback on action taken on pharmacies in your network even if they are not included in the attached list can be sent to CMS within 30 days of receipt of this memo.

Action: Applicable to PACE plans.  Refer to memo for further information.  Pharmastar will review the list of pharmacies and reach out to plans if a pharmacy they utilize for their participants has been identified as high risk assessment.

 

Coverage Gap Discount Program: July Participating Labeler Code Update –Dated 6/30/2016

Summary: CMS will update the manufacturer labeler codes for the Coverage Gap Discount Program July 1, 2016.  The updates include:

Added:

  • 69543 Virtus Pharmaceuticals, LLC
  • 76439 Virtus Pharmaceuticals, LLC

Action: Although the Coverage Gap Discount Program does not apply to PACE, the participating labeler codes are applicable because only brand name prescriptions with NDCs from these codes are accepted for Part D payment.  Pharmastar has made the necessary software adjustments to accommodate for the updated codes.

 

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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