Revised Texas-Specific Reporting Requirements for Medicare-Medicaid Plans 2025
Relevant to: State Medicare-Medicaid Plan Handbooks, Enrollment and Payment Systems
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Introduction
The release of the updated Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements for Texas presents vital adjustments for Texas Medicare-Medicaid Plans (MMPs). This update, effective from February 28, 2025, encompasses revisions aimed at streamlining and clarifying reporting expectations, focusing on technical specifications and value sets. Essential changes have been highlighted for measures including TX1.3, TX4.13, and TX4.14, ensuring that the Texas MMPs align with the most recent guidance from the measure steward, NCQA/HEDIS.
Key Dates and Deadlines
- Date of the memo: February 28, 2025
- Previous version date: February 29, 2024
- Deadline for adoption of updated specifications and value sets: June 2, 2025
- Deadline for reporting measure TX4.17: April 30, 2025
PACE Compliance
This memo is relevant to PACE programs because of its implications on the alignment process and reporting requirements for dual-eligible plans. Dual-eligible participants in the PACE may be affected by the reporting and value sets specified for Texas Medicare-Medicaid Plans.
Plans must use the updated specifications and value sets for measures due on or after June 2, 2025, as specified in the memo. This includes adhering to the updated Prevention Quality Indicators technical specifications when reporting certain measures, such as TX4.17, by April 30, 2025.
Non-compliance with the revised requirements will likely result in increased scrutiny or potential penalties. Therefore, PACE programs indirectly affiliated with dual-eligibles should ensure that their data collection and reporting processes are updated accordingly to align with these expectations.
In summary, PACE programs should:
- Review the revised Texas-Specific Reporting Requirements and Value Sets Workbook.
- Update data collection processes to incorporate new value sets and specifications.
- Ensure timely submission of reports by the specified deadlines to avoid non-compliance issues.
Required Actions
1. Review the revised Texas-Specific Reporting Requirements and Value Sets Workbook for updates to technical specifications and applicable codes.
2. Carefully review and incorporate the updated value sets, particularly for measures TX1.3, TX4.13, and TX4.14, for measures due on or after June 2, 2025.
3. Use the latest Prevention Quality Indicators technical specifications when reporting measure TX4.17 on April 30, 2025.
FAQs
- What are the revised Texas-Specific Reporting Requirements for Medicare-Medicaid Plans?
- When should Texas MMPs use the updated value sets?
- What changes were made to Measure TX4.13?
- How should Texas MMPs report measure TX4.17?
