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

Announcement of the November 2016 Software Release –Dated 9/9/2016

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

  • New Fields on the Beneficiary Eligibility Query
  • Transaction Reply Codes for New Enrollments vs. Plan Benefit Package Change
  • Changes to Encounter Data Diagnosis Eligible for Risk Adjustment Report
  • New Part C Risk Adjustment Model beginning Payment Year 2017

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


P2P Workbook and Attestation Information –Dated 9/12/2016

Summary: Some Part D plans are unable to submit the P2P workbook and attestation successfully in HPMS due to system issues.  CMS will notify the plans when the issue has been resolved and extend the deadline to submit at that time.  All other plans are still expected to submit before the deadline at noon ET, September 12, 2016.

Action: Applicable to PACE plans.


Contract Year 2016 Part D Formulary Administration Analysis –Dated 9/12/2016

Summary: CMS will be performing the enhanced formulary administration analysis (FAA) for CY 2016. This program will evaluate whether Part D plans are appropriately adjudicating Medicare Part D drug claims consistent with Part D requirements and the plan’s CMS-approved benefits.  All Part D plans, including PACE organizations that submit a Part D formulary via HPMS are eligible for inclusion in the analysis. Part D plans that are selected for the participation in analysis will be notified and provided additional information.

Action: Applicable to PACE plans that utilizes a formulary. Refer to the memo for additional details.


Release of the Proposed 2017 Civil Money Penalty Methodology for Comment Auto forwarded by a Rule –Dated 9/13/2016

Summary: CMS released the proposed methodology for calculating Civil Money Penalty (CMP) for Plan Year 2017.  Plans who would like to comment on the 2017 CMP methodology can submit comments to the provided email address by 5pm ET on October 13, 2016.

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


PACE- Initial Application Quarterly Submission Window –Dated 9/15/2016

Summary: The quarterly submission window for initial PACE applications is now live in HPMS.  Organizations interested in submitting an initial PACE application can do so by September 30, 2016.

Action: Applicable to PACE.  For PACE plans submitting initial PACE applications, refer to the email for complete details.


Contract Year (CY) 2017 Annual Notice of Change/Evidence of Coverage (ANOC/EOC) Errata Submissions Training –Dated  9/16/2016

Summary: CMS announced that the Annual Notice of Change and Evidence of Coverage (ANOC/EOC) Errata Submission Training is now available to plans online which provides an overview of the recent changes to the errata submission process.  

Action: Informational to PACE. Refer to the email to access the training.


2017 Reassignment of Low-Income Subsidy Beneficiaries in Prescription Drug Plans –Dated 9/19/2016

Summary: CMS will conduct reassignment of certain beneficiaries eligible for the Part D low-income subsidy in October.  CMS will carry out all reassignments including those to a different plan benefit package offered by the same organization, as well as to plans offered by different sponsors.  CMS will not reassign those who no longer qualify for LIS, or those who have chosen a plan on their own.  CMS will reassign only individuals who are LIS-eligible in 2016, as they will remain LIS-eligible in 2017.

Action: Informational to PACE. PACE organizations should review the memo in the event it may be applicable to the plan.


Draft 2017 Part C and Part D Reporting Requirements 30-day Comment Period –Dated 9/22/2016

Summary: CMS announced the opportunity for plans to comment on the proposed 2017 Medicare Part C and Part D Reporting Requirements.  Comments must be received by October 12, 2016.  

Action: Informational to PACE.  


Reporting and Returning Risk Adjustment Related Overpayments – Encounter Data –Dated 9/22/2016

Summary: CMS is providing plans with additional guidance for reporting and returning overpayments resulting from unsupported diagnoses that were submitted on encounter data records.

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


Update: Medicare Fraud Strike Force 2016 –Dated 9/22/2016

Summary: CMS updated the list of providers that were part of the investigation.  CMS is alerting plans of this information so plans can focus on the appropriate measures to detect and identify fraud, waste and abuse.

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.


November 2016 Updates to the Drug Data Processing System –Dated 9/22/2016

Summary: CMS announced changes to the Drug Data Processing System (DDPS).  The changes include modification to prescription drug event (PDE) edits 838 and 839 for the revised overpayment identification process.  In addition, a new PDE edit 844 will show up on PDEs if specific text value for the Service Provider ID is not populated.  The implementation date for the changes is November 13, 2016.  An updated prescription drug event (PDE) edit code listing spreadsheet will be posted to the CSSC Operations website.

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


Contract Year 2016 Quality Improvement Project Information for Medicare-Medicaid Plans –Dated 9/22/2016

Summary: CMS released information on the CY 2016 Quality Improvement Project Plan Section and Annual Update submissions for Medicare-Medicaid Plans.  

Action: Informational to PACE.


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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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