February 2023 Memos Archives

Completion of National Audit: Analysis of Prescription Drug Event Records for Nuedexta for Beneficiaries without a Medically Accepted Indication

February 2023 Memos / By PBM Updates

Relevant to: All Medicare Advantage Organizations (MAOs) and Prescription Drug Plan Sponsors (PDPs) The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC), conducted a National Audit of Medicare Part D Payments for Nuedexta prescribed without a documented medically accepted indication (MAI) under the …

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Medicare Advantage Encounter Data Submission Performance Reports – Changes to Metrics in March 2023

February 2023 Memos / By PBM Updates

Relevant to: All Medicare Advantage, Cost, PACE, and Demonstration Organizations Systems Staff Submission Performance Reports (SPRs) have been sent to Medicare Advantage Organizations (MAOs) since 2019 to help plans review instances where their encounter data submission patterns appear particularly low and for which technical assistance and feedback from CMS may be appropriate. See the full …

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2023 Data Validation of Medicare Part C and Part D Reporting Requirements Data

February 2023 Memos / By PBM Updates

Relevant to: All Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans As provided under 42 C.F.R. §422.516(g) and §423.514(j), Part C and Part D sponsors must participate in annual retrospective data validation (DV) of the Part C and D reporting requirements data. See the full guidance for more information.

NOTICE: February Drug Manufacturer Call on Implementation of the IRA Medicare Provisions

February 2023 Memos / By PBM Updates

Relevant to: All Drug Manufacturers The purpose of this memorandum is to notify drug manufacturers that the Centers for Medicare & Medicaid Services (CMS), Center for Medicare hosts monthly calls on implementation of the Medicare provisions of the Inflation Reduction Act of 2022 (Public Law 117-169). See the full guidance for more information.

Annual Coordination of Benefits-Other Health Insurance (COB-OHI) Full Replacement File for 2023

February 2023 Memos / By PBM Updates

Relevant to: All Prescription Drug Plans, Medicare Advantage-Prescription Drug Plans, Section 1876 Cost Plans, Medicare-Medicaid Plans, and PACE Organizations. The purpose of this memorandum is to notify Part D sponsor staff responsible for the receipt and processing of coordination of benefits files from the Centers for Medicare & Medicaid Services (CMS) of the upcoming annual …

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Calendar Year 2024 Preliminary Hospice Capitation Payment Rate Actuarial Methodology for the Hospice Benefit Component of the Medicare Advantage Value-Based Insurance Design Model

February 2023 Memos / By PBM Updates

Relevant to: Medicare Advantage Organizations Beginning in calendar year (CY) 2021, within the Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component, the Centers for Medicare & Medicaid Services (CMS) is testing the impact on quality and program expenditures of incorporating the Medicare Part A hospice benefit into the Medicare Advantage (MA) program with the goal …

Calendar Year 2024 Preliminary Hospice Capitation Payment Rate Actuarial Methodology for the Hospice Benefit Component of the Medicare Advantage Value-Based Insurance Design Model Read More »

Completion of the Coverage Gap Discount Reconciliation for Benefit Year 2021

February 2023 Memos / By PBM Updates

Relevant to: All Part D Sponsors The Centers for Medicare & Medicaid Services (CMS) completed the calculations for the 2021 Final Part D Coverage Gap Discount (CGD) Reconciliation. See the full guidance for more information.

Release of 2023 MIPS Payment Adjustment Data File

February 2023 Memos / By PBM Updates

Relevant to: All Medicare Advantage Organizations, Prescription Drug Plans, Cost Plans, PACE This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors serving individuals dually eligible for Medicare and Medicaid with additional guidance on the obligation to refund any payments of excess cost sharing. See the full guidance for more information.

2023 Medicare Part D Low-Income Subsidy (LIS) Income and Resource Standards

February 2023 Memos / By PBM Updates

Relevant to: All Prescription Drug Plan Sponsors, Medicare Advantage Organizations, Cost Plans, Programs for All-Inclusive Care for the Elderly This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors serving individuals dually eligible for Medicare and Medicaid with additional guidance on the obligation to refund any payments of excess cost sharing. See …

2023 Medicare Part D Low-Income Subsidy (LIS) Income and Resource Standards Read More »

Completion of the Reopening of the 2017 Final Part D Payment Reconciliation

February 2023 Memos / By PBM Updates

Relevant to: All Organizations This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors serving individuals dually eligible for Medicare and Medicaid with additional guidance on the obligation to refund any payments of excess cost sharing. See the full guidance for more information.

February 2023 Memos

Completion of National Audit: Analysis of Prescription Drug Event Records for Nuedexta for Beneficiaries without a Medically Accepted Indication

Medicare Advantage Encounter Data Submission Performance Reports – Changes to Metrics in March 2023

2023 Data Validation of Medicare Part C and Part D Reporting Requirements Data

NOTICE: February Drug Manufacturer Call on Implementation of the IRA Medicare Provisions

Annual Coordination of Benefits-Other Health Insurance (COB-OHI) Full Replacement File for 2023

Calendar Year 2024 Preliminary Hospice Capitation Payment Rate Actuarial Methodology for the Hospice Benefit Component of the Medicare Advantage Value-Based Insurance Design Model

Completion of the Coverage Gap Discount Reconciliation for Benefit Year 2021

Release of 2023 MIPS Payment Adjustment Data File

2023 Medicare Part D Low-Income Subsidy (LIS) Income and Resource Standards

Completion of the Reopening of the 2017 Final Part D Payment Reconciliation

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