Learn more about CMS Updates that may impact your PACE Plan. FEATURED UPDATE: Enhancements to the Contract Year 2018 Medicare Plan Finder
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Learn more about CMS Updates that may impact your PACE Plan.

Reminder of CY 2018 Plan Benefit Package and Additional Demonstration Drug (ADD) File Submission Deadlines for Medicare-Medicaid Plans (MMPs) – Dated 5/19/2017 

Summary: CMS reminds plans that the PBP submissions for CY 2018 are due no later than June 5, 2017 along with other file submissions and their deadlines for Medicare-Medicaid Plans.

Action: Informational to PACE.

 

Part C and D Star Ratings: Members Choosing to Leave the Plan detail available for review – Dated 5/22/2017

Summary: The Medicare Part C and D Star Ratings detail data for the beneficiary-level disenrollment is now available for distribution to contracts to review.  Instructions on how to request the disenrollment data for review can be found in a previous memo as referenced in the email.

Action: Informational to PACE.

 

Enhancements to the Contract Year 2018 Medicare Plan Finder – Dated 5/22/2017

Summary: CMS enhanced the benefit package data display on the Medicare Plan Finder for Contract Year 2018 which is scheduled to go live on October 1, 2017.  A list of the enhancements made is included. 

Action: Informational to PACE.

 

Update to the CY2018 Part D Model Materials – Dated 5/23/2017

Summary: CMS updated the zip file with a revised CY 2018 LIS Rider and added the model Prescription Transfer Letter.  

Action: Informational to PACE as PACE plans do not follow the MAPD marketing guidelines.  

 

Termination of Coverage Gap Discount Program Agreement for New Haven Pharmaceuticals, Inc. P1438, Labeler Code 58487 – Dated 5/23/2017

Summary: CMS announced the Coverage Gap Discount Program Agreement with New Haven Pharmaceuticals, Inc will be terminated as of June 1, 2017.  Applicable drugs with labeler code 58487 will no longer be covered under Medicare Part D.

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 will make the necessary software adjustments to accommodate for the change.

 

Guidance for Submitting State Medicaid Agency Contracts – Dated 5/25/2017

Summary: CMS provided guidance to MAOs seeking to offer a Dual Eligible Special Needs Plan in CY 2018 regarding contract requirements and submission deadlines.  

Action: Informational to PACE.

 

Coverage Gap Discount Program: June Participating Labeler Code Update – Dated 5/26/2017

Summary: CMS will update the below participating manufacturer labeler codes for the Coverage Gap Discount Program by June 1, 2017 to include:

Added:

  • 70437 Puma Biotechnology

Deleted:

  • 58487 New Haven Pharmaceuticals, Inc.

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 will make the necessary software adjustments to accommodate for the change.

 

Long-Term Institutional Resident Report – Date 5/26/2017

Summary: The memo announced the distribution of the second 2017 Long-Term Institutionalized (LTI) Resident Report on June 1, 2017 to plans who have LTI enrollees.

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

 

Medicare Advantage/Prescription Drug System (MARx) June 2017 Payment – INFORMATION – Dated 5/26/2017

Summary: CMS released information about the June payment and other payment related items that may require plan action:

  • Coverage Gap Discount Invoice Offsets
  • Incorrect Adjustments for Some Disenrollments
  • Incorrect Community Risk Factor Used in 2017 Payments
  • Late Enrollment Penalty LEP Cleanup
  • Health Information Technology for Economic & Clinical Health Act Bonus Payments for 2016

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

 

Contract Year 2018 Agent and Broker Compensation Rate Adjustments, Submissions, and Training and Testing Requirements – Dated 5/30/2017

Summary: CMS provided CY 2018 compensation limits for agents and brokers, directions for submitting amounts into the HPMS as well as training and testing requirements.  

Action: Informational to PACE as PACE plans are not authorized to utilize agents and/or brokers for enrollment purposes.

 

Medicare Part D Prescriber Enrollment – Dated 5/30/2017

Summary: CMS will no longer be planning the multifaceted phase approach prior to the Part D Prescriber Enrollment Requirement enforcement date January 1, 2019; therefore, plans should not expect any additional guidance regarding the phase approach.  

Action: Applicable to PACE.  Refer to the memo for complete details.  Additional information on the requirement can be found in previous memos as mentioned.

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Contract Year (CY) 2018 Initial Actuarial Certification Deadline – Dated 5/31/2017

Summary: As part of the CY 2018 bid submission requirements, an actuarial certification must be submitted via the HPMS actuarial certification module for every Bid Pricing Tool uploaded to HPMS.  The module is now available and all initial certifications are to be completed by June 9, 2017.  If a certification is not submitted via HPMS, the bid(s) will not be considered for CMS review or approval.

Action: Informational to PACE. PACE plans should review the status of this requirement with their respective actuaries.

 

Updates to the Reopening Request Spreadsheet – Dated 6/1/2017

Summary: CMS modified the Reopening Request Spreadsheet which will go into effective on June 5, 2017.  The Reopening Request Spreadsheet is used to report overpayments related to PDE data and DIR data.  It is available on the Part D Payment Process Support web portal in Acumen.  

Action: Applicable to PACE.  Refer to the memo for complete details and additional information on overpayment reporting and reopening request process.

 

2016 Medicare Health Outcomes Survey (HOS) Baseline and Medicare HOS-Modified (HOS-M) Reports – Dated 6/1/2017

Summary: CMS announced the availability of the following reports and data for participating Medicare managed care plans:

  • 2016 Medicare HOS Cohort 19 Baseline Report
  • 2016 Medicare HOS-Modified Report

Action: Informational to PACE plans.  For plans who participated in the 2016 Cohort 18 Baseline or 2016 HOS-M, refer to the memo for further details on the reports.

 

Agenda Available for CMS’ 2017 Programs of All-Inclusive Care for the Elderly (PACE) Conference & Webcast (July 20, 2017) – Dated 6/2/2017

Summary: CMS released the conference agenda for the 2017 PACE Conference & Webcast for July 20, 2017.  

Action: Informational to PACE.  For individuals who would like to participate, refer to the email for additional details on the event and how to register. 

 

IMPORTANT DATE REMINDERS:

Date

      Item

June 29, 2017

CY 2016 Final PDE Submission Deadline

TBD

CY 2016 Direct and Indirect Remuneration (DIR) Submission Deadline

July 1 – July 31, 2017 11:59 PM PT

CY 2013-2015 Direct and Indirect Remuneration (DIR)

Re-submission Period (If any changes or errors)

April 2018

Social Security Number Removal Initiative (SSNRI) to Begin

January 2019

Enforcement Date for the Prescriber Enrollment Requirement

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