In case you missed the most recent release of the update to the Plan Communications User Guide 5.3, here is the link. Download and review! http://www.cms.gov/MAPDHelpDesk/02_Plan_Communications_User_Guide.asp
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Part C
PCUG 5.3 Released
MA Plan Member Lock In – GONE in 2012!
With the issuance of a single memo, CMS has in effect removed the member lock in for MA and MAPD plans with the creation of a new SEP in 2012. The new SEP applies to all members who are enrolled in plans with a STAR rating below a 5 or are enrolled in original...
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CMS Reiterates Standards for Selecting a Data Validation Contractor
MA, MAPD and PDP plans are required to report measures to CMS for Part C and D benefits. Additionally, plans are required to contract with an outside vendor to review and validate the data that was submitted to CMS. Attached is CMS’s standards that plans should use to select a validation vendor. Vendor should...
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CMS Releases Proposed Changes to MA and MAPD Programs for CY 2012
CMS on November 10, 2010 release the proposed changes to the MA and MAPD program for CY 2012. The proposed rule changes will is expected to be published in the federal register on November 22, 2010. A headline summary of changes is as follows: Implementing provisions of the Affordable Care Act; Clarifying various program...
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CMS Posts New ICD-9 / HCC Crosswalk for 2011
CMS has posted an updated Calendar Year 2011 Model Diagnoses crosswalk on the Risk Adjustment webpage. The crosswalk incorporates Fiscal Year 2011 ICD-9 code updates that are effective October 1, 2010. The crosswalk file link is named “2011 Model Diagnoses” and can be found on the CMS Website here: http://www.cms.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp
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Part C Plan Ratings Preview
Today CMS provided guidance on the preview Part C Plan rating data that has been made available to plans. —————————-FROM HPMS—————————– To: Part C Compliance Officers From: Cynthia G. Tudor, Ph.D., Director, Medicare Drug Benefit and C & D Data Group Date: September 24, 2010 We have updated the Part C data included in...
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HEADS UP: CMS To Announce Encounter Submission Meeting in Oct 2010
During a breakout session at AHIP on September 13, 2010 CMS announced that there will be an October 2010 meeting where CMS will be reviewing the preliminary files, processes and expectations for MA health plans to transition from submitting RAPS files to ‘full encounter’ data. No details were shared at AHIP, but there is...
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CMS Announces STAR Rating Preview and Comment Period
CMS has released a HPMS memo letting MA and MAPD plans know they will be provided a preview period of the STAR Rating that will be published on the Medicare Plan Finder (MPF)for the 2011 open enrollment period. In August 2010 plans were provided a preliminary preview and now the final results are in....
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Additional Changes to 2011 ANOC/EOC
From CMS via HPMS on Sept 3, 2010: “On August 11, 2010, we issued a memo describing corrections to the 2011 Annual Notice of Change/Evidence of Coverage. We have the following additional corrections. 1 – Under the bullet, EOC Chapter 4, section 2.1, Your medical benefits and costs as a member of our plan,...
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CMS Updates MAPD and Cost Plan 2010 Reporting Tech Specifications
CMS has posted an update their 2010 MA Part C and Cost Plan Technical Reporting Specifications. The update contains clarifications to commonly asked questions from plans. Part C reporting is a compliance requirement and plans that fail to submit data on time and in good fail will receive a compliance letter and notification. The...
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