Transcript HPMS Bid Submission & PBP 2013

HPMS Bid Submission &
PBP 2013
Don Freeburger, Lucia Patrone, &
Sara Silver
HPMS Analysts
1
Agenda
•
•
•
•
Key Bid Submission Dates
Bid Upload Requirements
HPMS Access
PBP 2013 High Level Changes
2
Key 2013 Bid
Submission Dates
3
Key Bid Dates
• April 6, 2012 – CY 2013 Bid Pricing Tool (BPT), Plan
Benefit Package (PBP) and plan creation are available on
HPMS
• April 20, 2012 – PBP Patch for Capitated Financial
Alignment Demonstrations
• May 11, 2012 – HPMS begins accepting CY 2013 bid
submissions
• June 4, 2012 – Deadline for submitting CY 2013 bids in
HPMS (11:59 p.m. PDT)
4
Bid Upload Requirements
5
Bid Upload
• To complete the bid upload process, users must perform the
following functions in HPMS, as applicable:
• Service Area Verification
• Will be available April 27, 2012
• Crosswalk formulary submissions to plans
• Only for plans that offer the Part D benefit AND have a
formulary
• Cannot be modified after bid deadline
6
Bid Upload - Continued
• Upload bids/benefit packages
• May upload more than one plan at a time
• Upload early – you may upload as many times as you want
before the deadline
• Substantiation
• Required for June 4th deadline and upon request by bid
reviewers (Appendix B – BPT instructions)
7
Bid Upload – Plan Crosswalk
• Plan Crosswalk
• Only for renewing organizations
• Cannot be modified after bid deadline
• Plans should ONLY have the crosswalk status of “terminated”
if you will not offer the plan for CY 2013 OR for certain
crosswalk exceptions
• Renewal plans under the same contract MUST retain the
same plan ID
• Consolidated plans under the same contract MUST retain one
of the 2012 plan IDs
8
Exceptions Crosswalk
• Permitted crosswalk exceptions are outlined in the Medicare
Managed Care Manual and Appendix B-2 of the CY2013
Call Letter
• Additional guidance on the process to request an exception
is forthcoming via an HPMS Memo
• Plans may request crosswalk exceptions from June 11 –
June 15, 2012
• Approved Crosswalk Exceptions will display in the plan
crosswalk report in HPMS
• Please send questions to:
[email protected]
9
Verification of Bid Submission
• To verify that all necessary steps have been taken for the
bid submission, users should access the Review Upload
Status Report
• This report shows what is completed, not completed and not
applicable
• All bid submission AND Post-Bid submission items are
documented in this report
• If all steps have not been completed, CMS cannot begin
your bid review
• Navigation (Plan Bids > Bid Submission > CY 2013 >
Upload)
10
Post-Bid Submission Requirements
• Actuarial Certification
• Must be submitted for every Bid Pricing Tool uploaded to
HPMS
• Special HPMS user access required
• Supplemental Formulary Upload
• Required based on answers in PBP
• Financial Alignment Demos have an additional plan drug file
due June 15, 2012
• Submission of Provider Specific HSD
• Due for non-employer plans by June 15, 2012
11
HPMS ACCESS
•Obtaining a CMS / HPMS User ID
•HPMS Login Process
•Maintaining HPMS Access
12
Applying for HPMS Access
• Download a copy of the Application for Access to CMS Computer
Systems form at:
http://www.cms.hhs.gov/InformationSecurity/Downloads/EUAacce
ssform.pdf
• Complete the form as follows:
• Section 1 – Check “New” as the type of request
• Section 2 – Check “Medicare Advantage / Medicare Advantage with
Prescription Drug / Prescription Drug Plan / Cost Contracts – Using
HPMS Only”. Complete the other data entry fields, as appropriate
• Section 3 – Enter the contract number(s) for which you need access
• Section 4 – Check the first row beneath the "Default Non-CMS
Employee” row (i.e., place a check in the Connect box of the third
row). On the blank line beside your check mark, write
"HPMS_P_CommlUser"
• Section 5 – State briefly that you require HPMS
• Section 6 – Leave blank
• Sign and date the Privacy Act Statement on page 3 of the form. Also
enter your name and Social Security Number at the top of page 3.
This step is critical to ensuring the successful processing of your
request
13
Apply for HPMS Access - Continued
• Send the completed form to the attention of Lori Robinson
via an expedited mail service as soon as possible:
ATTENTION: LORI ROBINSON
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Mail Stop: C4-18-13
Baltimore, MD 21244
• On each individual’s form, please ensure that it includes an
original signature/date, social security number and the
contract number(s) for which the user needs HPMS access
14
HPMS Login Process
https://gateway.cms.gov
The user must
enter a valid
CMS-issued user
ID and password
in the appropriate
fields. In
addition, the user
must select
HCFA.GOV as the
Login Service.
Next, the user
clicks on the
Login button
15
HPMS Login Process
Click on link labeled “HPMS”
This screen
provides a link
to HPMS by
selecting this
link; the user
will be taken to
the HPMS
Homepage
16
HPMS Login Process
HPMS Home Page
17
User ID Maintenance
• Passwords must be changed every 60 days
• New Password characteristics
•
•
•
•
8 characters, no more, no less
Alphanumeric
No special characters, no commonly used words
Not similar to previous passwords
• ID must be certified annually on anniversary of issue date
•
•
User receives reminder/nuisance emails
Link for completing certification online/changing
password
• https://vpnext.cms.hhs.gov
18
Annual Certification Process
• Online or Manually
• Online at https://vpnext.cms.hhs.gov/EUA
• Manually by submitting access form
19
Certification Notification Email
•
•
>From: [email protected] [mailto:[email protected]]
>Sent: Wednesday, March 21, 2012 1:44 AM
>To: [email protected]>Cc: Freeburger, Don (CMS/CPC)
>Subject: 11 Day Warning for CMS Certification - ACTION
>
>Lucia Patrone
>GOVT - HPMS- PACE
>
>Your CMS User Id is DUE for Certification. Our records show that you have
>not completed System Access Certification. Your revocation date is 20120401.
>Unless all requirements are met within the next 11 day(s), your CMS User Id
>will be revoked. You must:
>
> * Certify your CMS System Accesses at
>
> https://euapassport.cms.hhs.gov/PassPort (for CMS internal users)
> or
> https://158.73.79.141/PassPort (for external MDCN users)
> or
> https://vpnext.cms.hhs.gov/EUA (for Internet users)
>
>NOTE: Please use Microsoft Internet Explorer 7.0 or above when accessing EUA
>Passport.
>
>and it must be approved by:
20
Online Certification Process
21
Online Certification Process
Enter User ID and
Password to Login
22
Online Certification Process
Enter User ID and
Password
“Again” to Login
23
Online Certification Process
24
Plan Benefit Package (PBP)
and Summary of Benefits (SB)
CY 2013 Software Changes
25
PBP 2013 Training Agenda
Objective: Focus on CY 2013 Technical Changes
• Describe Key PBP CY 2013 Software changes
• Describe Key SB CY 2013 Changes
26
PBP CY 2013 Section A Changes
27
Section A
• The plan-level formulary, online provider and pharmacy websites
have been updated as follows on the Section A-3 screen:
• If a plan enters a plan-level website in the HPMS, then the plan-level
website will automatically populate for the associated field
• If the plan enters a contract website in the HPMS, but does not enter
a plan-level website, then the contract-level website will
automatically populate for the associated field
• Plans may indicate that prior authorization and/or referrals are
required when submitting a “Standard Bid” for PBP Sections B or
C on the Section A-5 screen
• Plans will choose what services require authorization and/or referral
by making selections from a picklists
• The picklists will only contain categories that have
referral/authorization questions available elsewhere in the PBP
28
PBP CY 2013 Section B Changes
29
Section B CY2013 Changes
• Section B-1: Inpatient Hospital Services
• Plans that offer both Part A and Part B will be allowed to
have up to three hospital cost-share tiers for In-Network
Medicare-covered benefits within B-1a (Inpatient HospitalAcute) and B-1b (Inpatient Hospital-Psychiatric)
• If offering hospital cost-share tiers, a plan is not allowed to
offer more than one tier with Medicare-defined standard
cost-sharing
• Section B-4: Emergency Care/Urgently Needed Care
• All PFFS plans will have B-4b: Urgently Needed Care
enabled for data entry
• Section B-7: Health Care Professional Services
• The In-Area Network Urgent Care Services questions have
been removed from B-7a
30
Section B CY2013 Changes (Continued)
Section B-11: DME, Prosthetics, and Medical & Diabetic
Supplies
• The following question has been added to the B-11a (DME) –
Base 2 screen:
• Are there preferred vendors/manufacturers for Durable Medical
Equipment (DME)?
• The following question has been added to the B-11c (Diabetic
Supplies and Services) – Base 2 screen:
• Do you limit Diabetic Supplies and Services to those from specified
manufacturers?
Section B-13: Other Supplemental Services
• An Other 3 (B-13f) has been added as a new category in the PBP
• An edit rule has been added requiring that the title entered for the
B-13d: Other 1, B-13e: Other 2, and B-13f : Other 3 must be
more than two characters and the benefit may not be titled “other”
31
New Section - Section B – 13g
Section B-13g: Highly Integrated D-SNP
• New category added to the PBP for 2013 for SNP plans.
Only eligible plans should complete this data entry
• The format of the data entry screens will mirror the Other 1,
2, and 3 screens
• SNP plans will not be required to complete the Other 1, 2
and 3 screens and will be able to skip directly to the new
13g: Highly Integrated D-SNP Benefit
32
New Section - Section B – 13h
Section B-13h: Additional Benefits
•
•
New category added to the PBP for 2013 for Capitated Financial
Alignment Demo plans ONLY
This section will allow for data entry of the following 14 identified
services:
Early And Periodic Screening,
Diagnostic, And Treatment (EPSDT)
Services
Tobacco Cessation Counseling For
Pregnant Women
Freestanding Birth Center Services
Respiratory Care Services
Family Planning Services
Nursing Home Services (Long Term)
Home And Community Based Services
Personal Care Services
Self-Directed Personal Assistance
Services
Private Duty Nursing Services
Case Management (Long Term Care)
Institution For Mental Disease Services
For Individuals Age 65 Or Older
Services In An Intermediate Care
Facility For The Mentally Retarded
Case Management
Capitated Financial Alignment Demo plans are not required to complete
the Other 1, 2, and 3 screens and will be able to skip directly to the new
13h: Additional Benefits
These new screens will be available in a PBP release on April 20, 2012
33
PBP 2013 Section C Changes
34
Section C
Out-of-Network (OON) and POS:
• The OON and POS data entry has been updated so that the
Medicare-covered and Non-Medicare-covered benefits are
in separate picklists
• The rule that states “no coinsurance over 50%” will apply to
the Medicare-covered OON picklists, but not the NonMedicare-covered picklists
• All Mandatory Supplemental Benefits selected in Section B
must be included in the appropriate Section C - OON or
POS Group
POS:
• Medicare Part B Rx Drugs has been added to the POS
picklists
35
PBP 2013 Section D Changes
36
Section D
• The plan-level deductible questions have been updated for
RPPO and LPPO plans, so that the plan may choose to
have a combined deductible. If the plan does offer a
combined deductible, the following parameters must be
followed:
• The plan may include or exclude any Non-Medicare covered
supplemental benefit from the deductible In-Network or Out-ofNetwork
• The plan cannot offer a separate In-Network or Out-ofNetwork Deductible
• The plan may exclude from the combined deductible any InNetwork Medicare-covered service
• The MOOP questions have been updated as follows:
• Plans select the services that are included in a given MOOP
37
PBP 2013 Section Rx Changes
38
Section Rx
• The entire Rx Section has been redesigned
• The supplemental formulary file upload date has been
updated to June 8, 2012 to reflect the CY2013 deadline
• All prorated cost-sharing questions and labels have been
removed
• The Rx tier label selection process has been updated for all
Non-DS plans, where a plan chooses a Tier Model
• Some 5 tier plans and all 6 tier plans will allow for a tier with a
meaningful benefit to be chosen. Those options include
Specialty Drugs, Injectable Drugs, Vaccines, Excluded Drugs,
Select Care and Select Diabetic Drugs
39
Section Rx
• The Rx tier drug types, location and cost-sharing screens have
been reformatted so that all non-DS plans can fill out each tier’s
data on the same screen
• In-Network and Mail Order pharmacies will allow for one month, two
month, and three month supply amounts
• Long Term Care Pharmacies will collect one month and other day
supply amounts for Generic and Brand drugs
• The Generic Long Term Care Other day supply is optional and must be less
than the one month supply amount that is entered for Long Term Care
generic drugs
• The Brand Long Term Care Other day supply field is mandatory and must
have a value between 1 and 14 days
• An optional daily copayment field has been added with a
validation that the daily cost-share must be less than the one
month copayment divided by 30
• Plans must enter the “Average expected cost-sharing 1 month”
amount based on their Prescription Drug Event (PDE) data for
each In-Network retail one month coinsurance
40
Section Rx – Gap Coverage
• The following questions have been deleted from the
Alternative - Gap Coverage Screen: "Are you offering any
excluded drugs as part of your gap coverage?” and "Does
the gap coverage on this tier only include excluded drugs?"
• If a plan indicates it offers a “Partial Tier Coverage” on the
Alternative – Tier Coverage - Gap screen for a tier that
covers both generic and brand drugs, the following question
must be answered: “Indicate the type of drugs covered on
your partially covered tiers”
• The gap cost-sharing validations have been updated as
follows:
• Additional generic gap coverage coinsurance must be less
than or equal to 59%
• Additional brand gap coverage coinsurance must be less than
or equal to 69%
41
Summary of Benefits
CY2013 Changes
42
Summary of Benefits – General
• The phrase "Medicare-covered Zero Cost-Sharing
Preventive Services" has been revised to "Medicarecovered Preventive Services" in the appropriate OON and
POS sentences
• The subcategories have been updated throughout the SB to
be listed as programs, visits, or services instead of benefits
• A new, unnumbered SB category has been added called
“Additional Benefits”. This SB category will only appear for
Capitated Financial Alignment Demo plans that have
entered benefits into PBP Section B-13h
• This new category will be available in the PBP release on April
20, 2012
43
Summary of Benefits – SB 23
• The list of preventive services covered under Original
Medicare at zero cost has been replaced in the plan column
with the following sentences:
$0 copay for all preventive services covered under
Original Medicare at zero cost-sharing. Any additional
preventive services approved by Medicare mid-year will
be covered by the plan or by Original Medicare
• Cost-sharing sentences have been added if a plan enters
mandatory benefits in the B-13d, B-13e, B-13f, and/or B-13g
Highly Integrated D-SNP Section(s) of the PBP
44
SB – 25 (Outpatient Prescription Drugs)
• The SB has been updated to reflect the updated Section Rx
changes with the new Tier model labels
• If a plan offers a daily supply or two-month supply in Section
Rx, new SB sentences will display
• The Long Term Care cost-sharing sentences have been split
into separate brand and generic drug sentences
• A new sentence generates when a plan selects "Yes" to the
question "Does plan utilize floor pricing?”
45
PBP/SB Contacts
•
•
•
•
•
•
PBP Software Technical Issues:
– Sara Silver
410-786-3330 [email protected]
– Lucia Patrone
410-786-8621 [email protected]
PBP/HPMS Technical Help Desk:
– Help Desk
800-220-2028 [email protected]
MA Benefit Operations & Policy Issues (MA PBP):
– MA Benefits Mailbox
https://MABenefitsMailbox.lmi.org
– Marty Abeln (Policy)
410-786-1032 [email protected]
– Russell Hendel (Policy)
410-786-0329 [email protected]
– Heather Hostetler (Policy)
410-786-4515 [email protected]
MA Marketing Operations & Policy Issues (MA SB):
– Elizabeth Jacob
410-786-8658 [email protected]
– Melissa Moreno
410-786-4790 [email protected]
Part D Benefit Operations & Policy Issues (Part D PBP):
– Kathleen Flannery
410-786-6722 [email protected]
– Rosalind Abankwah
410-786-2012 [email protected]
– Frank Tetkoski
410-786-5233 [email protected]
Part D Marketing Operations & Policy Issues (Part D SB):
– Rosalind Abankwah
410-786-2012 [email protected]
– Lisa Thorpe
410-786-3048 [email protected]
46