Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: September 2016 Medicare Parts C&D Fraud, Waste and Abuse Training
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Learn more about CMS Updates that may impact your PACE Plan.

Updated 2017 Star Ratings dataset for Plan Preview #1 –Dated 8/12/2016

Summary: CMS updated the dataset in HPMS for the 2017 Star Ratings Plan Preview.  There were a few issues but have now been corrected to the original data which was posted on August 8, 2016.  

Action: Informational to PACE.

 

September 2016 Medicare Parts C&D Fraud, Waste and Abuse Training –Dated 8/12/2016

Summary: CMS announced the September Medicare Part C & D Fraud, Waste and Abuse Training registration opening for individuals who are interested in attending.  The training will be held September 13-15, 2016.  A list of the topics that will be addressed in the training is provided.  

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

 

2015 Attestations of Prescription Drug Event Data (PDE), Direct and Indirect Remuneration (DIR) Data, Monthly Plan-to-Plan (P2P) Reconciliation Payments, and Attestation of Data –Dated 8/12/2016

Summary: The memo gives information related to the requirement to certify Part D data.  Attestations, which are now available through HPMS must be submitted according to the instructions provided by noon ET on Monday, September 12, 2016.

Action: Applicable to PACE.  Refer to the memo and attachments for attestation descriptions and detailed instructions.  Your Pharmastar Client Support Specialist will be providing the P2P reporting data and is available to assist with the process.  Contact your Specialist with any questions or concerns.

 

Invitation to Provide Feedback on the Contract Year 2017 Bid Pricing (Actuarial) Requirements –Dated 8/15/2016

Summary: CMS is seeking comments and suggestions on the Contract Year (CY) 2017 actuarial bid process.  Feedback period will take place from Monday, August 15, 2016 through Friday, August 26, 2016 5PM ET.

Action: Informational to PACE.

 

The PACE Organization (PO) Monitoring and Audit Process – 60 day comment period –Dated 8/15/2016

Summary: CMS is seeking comments and feedback on the 2017 draft PACE audit protocols for the PACE Organization monitoring and Audit Process.  The comment period closes on October 4, 2016.

Action: Information to PACE.  For PACE plans interested in providing comments, refer to the email for instructions on how to provide comments and where to find the corresponding documents.

 

Medicare-Medicaid Plans; New Errata Model Material –Dated 8/15/2016

Summary: CMS released the new Medicare-Medicaid Plan specific errata model material to help MMPs in creating their own errata notices.  The model material will be posted on the provided webpage link with other MMP marketing issuances.

Action: Informational to PACE.

 

Revisions to Enrollment Guidance for Medicare Advantage Organizations, Prescription Drug Plans and Medicare Cost Plans for Contract Year 2017 –Dated 8/15/2016

Summary: CMS released the enrollment and disenrollment guidance revisions for Contract Year 2017 for Medicare Advantage, Prescription Drug Plan, and 1876 Cost Plans.  All enrollments with an effective date on or after January 1, 2017 must be processed in accordance with the revised guidance.  

Action: Informational to PACE.

 

Contract Year (CY) 2017 “Medicare & You” Handbook – Plan Data Preview –Dated 8/15/2016

Summary: CMS is providing organizations the opportunity to preview how their plan data will appear in the Contract Year 2017 “Medicare & You” handbook.  The preview period will be August 18, 2016 through August 22, 2016 6PM ET.  Plans are strongly encouraged to review their data early to ensure any updates are reflected in a timely manner.

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

 

Release of the Contracts and Addenda for Contract Year (CY) 2017 –Dated 8/16/2016

Summary: CMS updated the Contract Year 2017 Contracts and Addenda to the HPMS Electronic Contracting Module.  Plans must execute contracts via the electronic signature process in HPMS by August 31, 2016 5PM ET.

Action: Informational to PACE as the guidance provided is not applicable to PACE organizations.

 

Update: New Session Topic Added for the 2016 Medicare Advantage & Prescription Drug Plan Fall Webcast & Conference (September 8, 2016) –Dated 8/16/2016

Summary: CMS included a new session topic “Reducing Inappropriate Billing to Qualified Medicare Beneficiaries” to the webcast and conference.  As a reminder, in-person registration will close on August 26th at 6PM ET. 

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

 

Pharmacy Directories and Disclaimers –Dated 8/16/2016

Summary: CMS provided guidance on pharmacy directories and certain disclaimers that no longer appear in the Contract Year 2017 Medicare Marketing Guidelines which was released on June 10, 2016.  Though the guidance has been removed, CMS clarifies that the guidance is still in effect and will be incorporated into the Chapter 5 of the Medicare Prescription Drug Benefit Manual.  

Action: Informational to PACE.  Refer to the memo for additional details.

 

Plan Preview Dates for 2017 Medicare Plan Finder –Dated 8/18/2016

Summary: CMS released the timeline and instructions for previewing plan benefit cost sharing data and out-of-pocket estimates for display in the 2017 Medicare Plan Finder (MPF) on Medicare.gov.  PACE organizations should ensure that their plan data displays accurately on MPF.  The MPF is scheduled to go live on Medicare.gov on October 1, 2016.

Action: Applicable to PACE. Refer to the memo for the plan preview schedule and additional details.

 

2nd Update to 2017 Star Ratings dataset for Plan Preview #1 –Dated 8/18/2016

Summary: CMS updated the dataset in HPMS for the 2017 Star Ratings Plan Preview.  There were a few issues but have now been corrected to the original data which was posted on August 12, 2016.  

Action: Informational to PACE.

 

Update on Chapter 6 Revisions –Transition Requirements and Expiring Formulary Exceptions –Dated 8/19/2016

Summary: CMS made clarification to whether transition requirements apply to expiring formulary exceptions and does not expect Part D sponsors to include expiring formulary exceptions in their transition policies.  However, the language in the Contract Year 2017 model transition letter which will be released soon can be use by plans that already apply transition rules to expiring formulary exceptions.

Action: Informational to PACE.

 

Release of Contract Approval Status Report –Dated 8/23/2016

Summary: CMS released the Contract Year 2017 Contract Approval Status Report in HPMS.  Organizations can use the report to identify proactively where incomplete data entry or submissions may preclude CMS from approving your contract for the upcoming contract year.  Organizations are encouraged to access this report.

Action: Informational to PACE.  

 

CGDP Preliminary Labeler Code Changes for Calendar Year 2017 –Dated 8/24/2016

Summary: The list of anticipated Coverage Gap Discount Program labeler changes scheduled for January 1, 2017 will include:

 Deletions:

00517  American Regent, Inc.

18657  Halozyme Therapeutics, Inc.

40042  PharmaForce, Inc.

*52722   Brookfield Therapeutics, LLC

*61364   BioCryst Pharmaceuticals, Inc.

69442  Vernalis Therapeutics Inc

Additions:

35781  Gensco Laboratories, LLC

52118  Theravance Biopharma

*69171   Merrimack Pharmaceuticals

69531  Telesta Therapeutics

69639  Helsinn Therapeutics (U.S.), Inc.

*69809   HLS Therapeutics (USA), Inc.

70114  Coherus BioSciences

70122  Cempra Pharmaceuticals, Inc

70127  GW Research Ltd.

70135  Infinity Pharmaceuticals, Inc.

70255  Array Biopharma Inc

70370  Neurocrine Biosciences, Inc.

*70614   Churchill 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.

 

Clarification of Guidance regarding the Nondiscrimination Communication Requirements and Grievance procedures Section 1557 of the Affordable Care Act –Dated 8/25/2016

Summary: CMS released clarification on the guidance regarding implementing the procedural requirements under Section 1557 of the Affordable Care Act of 2010- Nondiscrimination Communication Requirements and Grievance Procedures to answer questions on existing marketing materials and about what qualifies as a significant communication and publication.

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

 

In-person Registration Closing for the 2016 Medicare Advantage & Prescription Drug Plan Fall Webcast & Conference (September 8, 2016) –Dated 8/25/2016

Summary: CMS announced that the in-person registration for the CMS fall conference & webcast will be close on August 26th at 6PM ET.  The webcast registration will remain open for individuals who are interested in participating online.

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

 

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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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