Learn more about CMS Updates that may impact your PACE Plan. FEATURED MEMO: Revised Reporting Deadline for 2016 Part C and D Enrollment/Disenrollment Reporting Requirements Data
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Learn more about CMS Updates that may impact your PACE Plan.

Revised Reporting Deadline for 2016 Part C and D Enrollment/Disenrollment Reporting Requirements Data –Dated 8/26/2016

Summary: CMS updated the CY 2016 Medicare Part D Reporting Requirements Technical Specifications to correct a disenrollment data element’s definition and allowable value.  The change details are included in the email.

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

 

Additional Model Notices for CY 2017 –Dated 8/26/2016

Summary: CMS announced the release of the 2017 model notice for a transition fill under the Medicare Part D prescription benefit.  Additional, two new model notices on the provisional supply is provided for use once the Part D prescriber enrollment requirement goes into effect on February 1, 2017.  

Action: Informational to PACE.  The Part D prescriber enrollment requirement is applicable to PACE.  For additional information on the Part D prescriber enrollment requirement, it can be found on the CMS website.

 

Contract Year 2017 Annual Notice of Change/Evidence of Coverage/Errata Submission Requirements and Yearly Assessment –Dated 8/26/2016

Summary: CMS reminds plans on the key actions required for the Annual Notice of Change/Evidence of Coverage (ANOC/EOC) documents.  The ANOC/EOCs provide vital information to enrollees regarding benefits and cost-sharing.  CMS expects plans to send correct ANOC/EOCs to enrollees on time and in accordance with Medicare guidelines. Additional information on the ANOC/EOC instructions and Model Errata can be found in the link provided.

Action: Information to PACE. Refer to memo for additional details.

 

Medicare Advantage/Prescription Drug System (MARx) September 2016 Payment – INFORMATION –Dated 8/26/2016

Summary: CMS released information on the September payment which is schedule for September 1, 2016 and may require plan action:

  • 2016 Risk Adjustment Overpayment Re-Runs
  • National Medicare Education Campaign (NMEC) User Fees

Regional Post-Graft Payment Cleanups

Action: Information to PACE.  Refer to memo for items that may be applicable to your plan.

 

2017 Full Risk Contract Option Continuance –Dated 8/26/2016

Summary: CMS reminds plans that they have the choice of payment options for enrollees who have 12 months of entitlement to Part A and less than 12 months of Part B enrollment during the data collection year.  Plans can be paid for these enrollees as either “full risk” or “new enrollee” beneficiaries.  Plans can choose this option for their Part C and Part D risk scores.  Organizations that wish to confirm the status of their Full Risk Option election can access the Full Risk contract Option Election Data in HPMS by September 23, 2016.

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

 

2017 Full Risk Contract Option Election –Dated 8/26/2016

Summary: CMS reminds plans that they have the choice of payment options for enrollees who have 12 months of entitlement to Part A and less than 12  months of Part B enrollment during the data collection year.  Plans can be paid for these enrollees as either “full risk” or “new enrollee” beneficiaries.  Plans can choose this option for their Part C and Part D risk scores.  Organizations that wish to elect the Full Risk option for their Part A-only enrollees may access the Full Risk Contract Option Election Data in HPMS by September 23, 2016.

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

 

URGENT: Change to September 2016 Medicare Parts C & D Fraud, Waste and Abuse Training –Dated 8/30/2016

Summary: The Fall Medicare Parts C & D Fraud, Waste and Abuse Training hosted by CMS will be held as a virtual training rather than an in-person event.  Those who registered for the in-person event will automatically be registered for virtual training.  

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

 

ANOC/EOC Errata Submission Training –Dated 8/30/2016

Summary: CMS announced that the ANOC/EOC Errata Submission Training scheduled for September 26, 2016 will be replaced by a pre-recorded training that will be released later in September.  

Action: Information to PACE.

 

Update to Chapter 16b of the Medicare Managed Care Manual –Dated 8/30/2016

Summary: CMS updated Chapter 16b of the Medicare Managed Care Manual, titled “Special Needs Plans”.  Chapter 16b has been reorganized to provide greater clarity and revised to incorporate policy changes affecting special needs plans. 

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

 

Corrected Subject: MMP Provider and Pharmacy Directory Technical Assistance Webinar –Dated 8/31/2016

Summary: Logistical details for the Provider and Pharmacy Directory technical assistance webinar on September 7, 2016 from 1-3pm ET is provided to assist plans who will be participating in the webinar.

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

 

Medicare Fraud Strike Force 2016 –Dated 8/31/2016

Summary: As a nationwide takedown, the U.S Department of Health and Human Services and the Department of Justice indicted several Medicare providers and is alerting plans of this information so that plans can focus on the appropriate measures to detect and identify fraud, waste and abuse.  Enclosed is a list of providers that were part of the investigation.

Action: Informational to PACE.  Refer to the memo for complete details and the list of providers that were part of the investigation.  Pharmastar will review the list of pharmacies and notify your plan if any of the pharmacies listed had claims adjudicated for your members.

 

Request for Comments for the Draft 2018 Capitated Financial Alignment Service Area Expansion Application –Dated 9/1/2016

Summary: CMS requests for comments on the 2018 Capitated Financial Alignment Service Area Expansion Application.  All comments are due by September 9, 2016.  

Action: Information to PACE.  Refer to memo for additional details.

 

Long-Term Institutionalized Resident Report –Dated 9/1/2016

Summary: The memo announced the distribution of the third 2016 Long-Term Institutionalized (LTI) Resident Report to plans who have LTI enrollees.

Action: Informational to PACE plans with LTI enrollees.  Refer to the memo for details on how to retrieve the report and other general report details.

 

2017 National MMP Enrollment Guidance & Exhibits –Dated 9/3/2016

Sumary: CMS completed and finalized updates to the Medicare-Medicaid Plan National Enrollment Guidance & Exhibits.  The guidance will be in effective January 1, 2017 and is provided in advance to support efforts in operationalizing any necessary changes before January 1, 2017.

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

 

Release of the 2015 Medicare Part C and Part D Program Audit and Enforcement Report –Dated 9/6/2016

Summary: CMS released the 2015 Part C and Part D Program Audit and Enforcement Annual Report.  The report provides information on program audit process, current snapshot of the program audit landscape, and summary of the 2015 program audits and CMS enforcement actions. 

Action: Informational to PACE.  The annual report is attached to the email.

 

Follow Up to the MMP Provider and Pharmacy Directory Technical Assistance Webinar –Dated 9/8/2016

Summary: The MMP Provider and Pharmacy Directory Technical Assistance Webinar presentation is now available.  The link and pathway to the presentation is provided in the email.

Action: Informational to PACE.

 

Erroneous Dates of Death –Dated 9/8/2016

Summary: The Social Security Administration notified CMS that they processed incorrect beneficiary death terminations on August 10 and August 11, 2016.  Approximately 900 to 1,000 Medicare beneficiaries with North Dakota, South Dakota, and Virginia address were impacted.  SSA is working to correct these records but no timeline for completion has been announced.  

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

 

Release of Contract Year (CY) 2017 Plan Correction Module –Dated 9/8/2016

Summary: CMS released the HPMS Plan Correction Module for Medicare Advantage Organizations, Medicare Prescription Drug Plans and 1876 Cost Plans.  The correction module will be open from September 8, 2016 until September 21, 2016 at 11:59pm ET.  Only changes to the Plan Benefit Package that are supported by the Bid Pricing Tool are allowed during the plan correction period.

Action: Informational to PACE plans. Refer to memo for additional information.

 

Second Plan Preview of 2017 Star Ratings Data –Dated 9/8/2016

Summary: CMS informed Part C and Part D plans that they can preview their Star Ratings in HPMS prior to display on the Medicare Plan Finder.  The second preview will begin on September 9, 2016 to September 19, 2016 at 5pm ET.  The final Star Ratings can be viewable by beneficiaries on Medicare.gov in October.

Action: Informational to PACE plans. 

 

Lack of Transparency: Combat Deceptive PBM Practices

 

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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