CMS release though HPMS revised and more detailed requirements for the Spring 2011 MARX Software Release. The PDF is 50MB, you will need to go to HPMS to fetch.
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Author Archive
CMS Releases Update to Spring 2011 MARx Software Release
Managed Medication Management Can Impact STARS Ratings
Studies show that adding a pharmacist to the direct medical management team can have major positive results when managing patient care: major reduction in adverse drug reactions, fewer medication errors and higher quality of care and life. All of these results are measured in the CMS STARS ratings either explicitly or implicitly. It is...
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CMS Orders 3 Plans to Stop Marketing During 2011 AEP
CMS has order three private MA plans to stop marketing and enrollment activity: Universal American Corp. (UAM), Health Net Inc. (HNT) and Arcadian Health. Not a good time to stop enrolling members in the middle of the 2011 AEP! Further References: Kaiser Health News Stockton (Calif.) Record: “These sanctions will remain in effect until...
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MA Plans Responding to ACA – Retrenchment!
According to the WSJ on 11/19/10, the major public MA plans are responding to the legislative changes in the ACA of 2010 by diversifying from the once lucrative private MA business in 2011. Summary: Private plans are new renewing hundreds of Ma plans displacing over 700,000 lives who must find new coverage options Kaiser...
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GOVT Releases Final Medical Loss Ratio Regulations
The Obama administration today issued the final regulations on the much-discussed medical loss ratio. The health-care overhaul bill stipulates targets of 80% for small-business plans and 85% for large-company plans, but the industry had lobbied to make it easier in various ways for insurers to hit those benchmarks. (If they don’t, they’ll have to...
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PCUG 5.3 Released
In case you missed the most recent release of the update to the Plan Communications User Guide 5.3, here is the link. Download and review! http://www.cms.gov/MAPDHelpDesk/02_Plan_Communications_User_Guide.asp
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MA Plan Member Lock In – GONE in 2012!
With the issuance of a single memo, CMS has in effect removed the member lock in for MA and MAPD plans with the creation of a new SEP in 2012. The new SEP applies to all members who are enrolled in plans with a STAR rating below a 5 or are enrolled in original...
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CMS Reiterates Standards for Selecting a Data Validation Contractor
MA, MAPD and PDP plans are required to report measures to CMS for Part C and D benefits. Additionally, plans are required to contract with an outside vendor to review and validate the data that was submitted to CMS. Attached is CMS’s standards that plans should use to select a validation vendor. Vendor should...
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CMS Releases Proposed Changes to MA and MAPD Programs for CY 2012
CMS on November 10, 2010 release the proposed changes to the MA and MAPD program for CY 2012. The proposed rule changes will is expected to be published in the federal register on November 22, 2010. A headline summary of changes is as follows: Implementing provisions of the Affordable Care Act; Clarifying various program...
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Upcoming Industry Conference: STARS in New Orleans
HEA is producing an industry conference on December 2nd and 3rd 2010 at the Roosevelt Hotel in New Orleans. Topics will include: CMS’ Proposed Rule to Incentivize Practitioners Quality Management and Quality Improvement Case Study: Early Adopter, Lovlace Health Plan New Trends in Medical Management: Integration Strategies And more! Contact www.healthcare-conferences.com for more information...
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