Changes for 2015 Part D Reporting Announced by CMS
The Centers for Medicare & Medicaid Services (CMS) recently released an updated version of the Contract Year 2015 Part D Reporting Requirements Technical Specifications.
Sponsors are required to undergo data validation to have some of their Part D data audited annually. Each Part D Sponsor is required to provide necessary data to CMS to support payment, program integrity, program management, and quality improvement activities. Additional reporting requirements are identified in separate guidance documents throughout the year.
REPORT DELETIONS
Long-Term Care (LTC) Utilization –
One notable change for 2015 reporting is the LTC Utilization section will be suspended effective immediately because similar information can be obtained using Prescription Drug Event (PDE) data. Similarly, CMS removed the LTC Utilization reporting section which reports information about the total number of beneficiaries in LTC facilities for whom Part D drugs have been provided because it is provided elsewhere in the Plan’s CMS contract.
Prompt Payment –
CMS removed Prompt Payment to Part D Sponsors and Fraud, Waste, and Abuse (FWA) reporting sections and decreased hour estimates associated with these sections because CMS determined these data are no longer necessary for monitoring through these reporting requirements.
CMS has determined the reporting of these data is no longer necessary for monitoring through FWA reporting requirements. Other methods using data validation processes have replaced the need for this reporting element. Annual Data Validation Audits, informatic analysis of PDE data, and other elements reported elsewhere meet the FWA monitoring goals of CMS.
REPORTING CHANGES
Medication Therapy Management (MTM) –
The addition of a note, reporting of Line Q, “Date(s) of Comprehensive Medicare Reviews (CMRs) with written summary in CMS standardized format,” has been reduced to two CMR dates, even if more have been completed. One CMR is required if the member meets eligibility requirements. After analyzing the data, CMS concluded only two dates are needed for monitoring purposes.
CMS provided clarification to Line S, “Qualified Provider who performed the initial CMR,” (Physician; Registered Nurse; Licensed Practical Nurse; Nurse Practitioner; Physician’s Assistant; Local Pharmacist; LTC Consultant Pharmacist; Plan Sponsor) to provide more descriptive choices.
The Technical Specifications for Part D Reporting document can be viewed in its entirety as posted on the Health Plan Management System (HPMS) Plan Reporting site and on the external CMS website by clicking this link.
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