http://www.cms.gov/MAPDHelpDesk/02_Plan_Communications_User_Guide.asp

What is not detailed in the memo are the restrictions of the new SEP.  Are these members allowed to only move to a plan with a higher STAR rating?  Can they only move to a plan with a 5 rating or back to original Medicare?  I guess these details will be communicated at a later date.  In short, this is a game changer for the 2012 bids!  Good luck.

HPMS MEMO: SEP to Enroll in 5-star plans

• Vendor should be independent of the MAO and not involved in the submission process
• Vendor should have previous experience in MA reporting requirements and technical specifications
• HIPAA compliant
• Prior experience in completing project of similar scope and size
• Staff must complete CMS web-based CMS Data Validation Training

See the attached document for further details of the standards:

Standards for Selecting a DV Contractor 20101012

• Implementing provisions of the Affordable Care Act;
• Clarifying various program participation requirements;
• Strengthening beneficiary protections;
• Strengthening Medicare’s ability to distinguish stronger health plans for participation in Medicare Parts C and D and to remove consistently poor performers; and
• Implementing other clarifications and technical changes.

One of the most notable changes is to the rule governing the 2012 Medicare Advantage Quality Bonus Payment Demonstration program.  The current ACA legislation only provides bonus to plans who receive an overall rating score of 4 or 5 stars (The average of the Part C and D scores).  Leaving no bonus to plans who score a 1,2, or 3 rating (See chart).

The rule change is intended to test if providing additional bounce opportunities at the 3 and 3.5 star level accelerate the progression of improvement of plans to higher STAR rating levels.  The demonstration program will run for 3 years from CY 2012 through 2014.

Based on the 2011 Star ratings, this change in bonus methodology significantly changes the number of plans who qualify for a bonus.  Under the original rules only 16 plans would have received a bonus.  Under the demo rules an additional 39 plans will receive a bonus totaling 55 plans.

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

—————————-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 the Plan Ratings Preview. The following changes are included in this update:

 1 – We have updated the timeliness of appeals measure (measure number C31). CMS had included some dismissals in this measure and we now have excluded all dismissals as a result your updated scores are now included in the preview data. The preview report includes your updated values for the domain focusing on Health Plan Member Complaints and Appeals. We have also updated your summary and overall plan ratings as a result of modifying the appeals measure. Because of these changes, please re-review these measures.

 2 – In the initial posting of the data the numeric values for the flu shot measure did not load correctly; however, the star values were correct. We updated last week the numeric values for this measure.

 3 – We have also found an error where the last 4 measures were loaded incorrectly into the database. This did not impact the scores shown for the domain, summary and overall ratings; however, it did impact the data in the preview report for measures C33 through C36. This has been corrected.

We have posted an updated version of the Technical Notes. Please remember that all comments and questions are due by October 1, 2010. All questions should be sent to PartCRatings@cms.hhs.gov.

• Plans will be allowed to send up to 2 representitives at this event
• There is an expected parallel submission period where plans will submit both RAPS and Encounter files.  No details on how and what will be monitored
• Encounter submissions are expected to start 1/1/2012
• Encounter data will replace RAPS data at some point and will be used for risk adjustment factor scores for Part C and D

None of the above is official from CMS but informally shared at AHIP.  Watch HPMS for details.

In August 2010 plans were provided a preliminary preview and now the final results are in. Make sure your plan review the scores and calculation methodology and make sure your scores are accurate.

Here is how your plan can access your documentation in HPMS:

“ To access the Plan Ratings Preview in HPMS, from the left navigation bar select: “Quality and Performance”, then “Part D Performance Metrics and Reports” and then “Part D Report Card Master Table”. Technical notes are available via the “Technical Notes” link found on the “Summary” tab of the Master Table.”

Here is the memo:  Memo_PlanRatingsPreview_09.10.10

“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, the standardized language should read, “Your provider will bill Original Medicare while your hospice election is in force.”

2 – Additionally, the current language in EOC Chapter 4, Kidney Disease Education Services, should read as follows:

“Education to teach kidney care and help members make informed decisions about their care.  For people with stage IV chronic kidney disease ,when referred by their doctor, we cover up to six sessions of kidney disease education services per lifetime.”

Please make the appropriate changes to your plan’s EOC, as applicable. Plans that have already submitted their EOC must resubmit the document with the revised language.  Please contact your Regional Office marketing reviewer if you have additional questions.”

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 updated specification memo can be retrieved from the CMS web site at this location:
http://www.cms.gov/HealthPlansGenInfo/Downloads/PtCReptTecSpecsFinal_06.03.10.pdf