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Contract Year (CY) 2024 Part D Pricing Data Submission Guidance

June 5, 2023

Relevant to: All Part D Plans

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Definition of Marketing

May 19, 2023

Relevant to:  Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Plans, Prescription Drug Plan Sponsors, and Section 1876 Cost Plans In order...

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Final Medicare Part D DIR Reporting Guidance for 2022

May 15, 2023

Relevant to: All Medicare Advantage Organizations

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Release of the Contract Year (CY) 2024 Bid Submission Functionality in HPMS

May 15, 2023

Relevant to: All Medicare Advantage Organizations

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NOTICE: April Drug Manufacturer Call on Implementation of IRA Medicare Provisions

April 16, 2023

Relevant to: All Organization Types and Stakeholders This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors...

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Release of the Contract Year (CY) 2024 Plan Benefit Package and Bid Pricing Tool Software and Related Technical Bidding Guidance for Employer/Union-Only Group Waiver Plans

April 16, 2023

Relevant to: All Current and Prospective Medicare Advantage (MA), Prescription Drug Plan (PDP), Section 1876 Cost, PACE, and Medicare-Medicaid Plan...

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Incoming File From CMS: Beneficiary-level File to Support 2024 Part D Bids

April 16, 2023

Relevant to: All MA-PD plans, 1876 Cost Plans, PACE organizations, and PDPs CMS has pushed out to all Medicare Advantage-Prescription...

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Incoming Files from CMS: Beneficiary-level File to Support 2024 Part C Bids & ESRD Risk Scores

April 16, 2023

Relevant to: All Medicare Advantage Organizations and Section 1876 Cost Plans CMS has pushed out to all Medicare Advantage (MA)...

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UPDATES – 2023 Medicare Part D Patient Safety Reports

April 16, 2023

Relevant to: All Prescription Drug Plans, Medicare Advantage-Prescription Drug Plans, Section 1876 Cost Plans, Medicare-Medicaid Plans, and PACE Organizations This...

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UPDATES – 2023 Medicare Part D Patient Safety Reports

April 16, 2023

Relevant to: All Prescription Drug Plans, Medicare Advantage-Prescription Drug Plans, Section 1876 Cost Plans, and PACE plans The purpose of...

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Release of the Non-Renewal/Service Area Reduction Module in the Health Plan Management System

April 15, 2023

Relevant to: All Medicare Advantage Organizations

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New 2025 Prescription Drug Event (PDE) File Layouts (FINAL)

April 15, 2023

Relevant to: All Medicare Advantage Organizations

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Supplemental Benefit Coverage of Over-the-Counter Naloxone

April 15, 2023

Relevant to: All Medicare Advantage Organizations

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Extension of the MA VBID

March 23, 2023

Relevant to: All Medicare Advantage Organizations

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Preparing for the CY 24 Bid Submission Process in HPMS

March 23, 2023

Relevant to: All Current and Prospective Medicare Advantage, Prescription Drug Plan, Section 1876 Cost, PACE, and Demonstration Organizations

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Part D Sponsors’ Access to the Medicare Plan Finder

March 20, 2023

Relevant to: All Prescription Drug Plans, Medicare Advantage-Prescription Drug Plans, and Section 1876 Cost Plans

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Long-Term Institutionalized Resident Report

March 15, 2023

Relevant to: All Medicare Advantage Organizations

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Instructions on Submitting Default Enrollment Renewal Applications in the Health Plan Management System (HPMS) for Plans with 5-year Approval End Dates Approaching

March 15, 2023

Relevant to: All Medicare Advantage Organizations

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COB-OHI Record Updates

March 11, 2023

Relevant to: All Medicare Advantage Organizations

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

February 16, 2023

Relevant to:  All Medicare Advantage Organizations (MAOs) and Prescription Drug Plan Sponsors (PDPs)   The Centers for Medicare & Medicaid Services...

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

February 16, 2023

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),...

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

February 16, 2023

Relevant to:   All Prescription Drug Plans, Medicare Advantage-Prescription Drug Plans, Section 1876 Cost Plans, Medicare-Medicaid Plans, and PACE Organizations.  The...

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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 16, 2023

Relevant to:  Medicare Advantage Organizations   Beginning in calendar year (CY) 2021, within the Value-Based Insurance Design (VBID) Model’s Hospice Benefit...

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Completion of the Coverage Gap Discount Reconciliation for Benefit Year 2021

February 16, 2023

Relevant to: All Part D Sponsors The Centers for Medicare & Medicaid Services (CMS) completed the calculations for the 2021...

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Release of 2023 MIPS Payment Adjustment Data File

February 16, 2023

Relevant to: All Medicare Advantage Organizations, Prescription Drug Plans, Cost Plans, PACE This memorandum provides Medicare Advantage (MA) organizations and...

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

February 16, 2023

Relevant to: All Prescription Drug Plan Sponsors, Medicare Advantage Organizations, Cost Plans, Programs for All-Inclusive Care for the Elderly This...

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

February 16, 2023

Relevant to: All Organizations This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors serving individuals dually...

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Public Health Emergency Resource Update

February 16, 2023

Relevant to: All Organizations This memorandum provides Medicare Advantage (MA) organizations and section 1876 cost plan sponsors serving individuals dually...

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Draft Contract Year (CY) 2024 Part D Bidding Instructions

January 16, 2023

Relevant to: All Prescription Drug Plans, Medicare Advantage-Prescription Drug Plans, Section 1876 Cost Plans, Medicare-Medicaid Plans, and PACE plans The...

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Medical Loss Ratio Data Form and Attestation Submission Reminder for Contract Year 2021

January 16, 2023

Relevant to: Medicare Advantage Organizations, Cost Plans, and Prescription Drug Plan Sponsors Each Medicare Advantage (MA) Organization, Cost Plan, and Part...

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