Health Plan Insurer Blog

CMS issued reporting changes for the ODR reporting section. Most notably, reporting is due annually on February 28 of the following year versus quarterly. Other updates to the ‘Additional Guidance’ include the following clarifications and additions to the language.

CMS issued changes to the Serious Reportable Adverse Events (SRAE) reporting section in February. For 2013, the following instructions were added to the technical specification:

Sometime in the next five years, it’s likely your plan will be audited. CMS confirmed that it is auditing 32 plans this year, and intends to audit all plans within three to five years. What can you do to prepare for your plan’s audit?

Consumer directed health plans entered the market more than 10 years ago to help participants understand the real cost of health care and how their choices impact that cost. Since then, many tools have been developed to help consumers become better buyers.

In February CMS issued updated guidance with these changes to the Special Needs Plans (SNPs) Care Management reporting section.

In April, CMS issued updated guidance with a change for the Long-term Care (LTC) Utilization reporting section. For 2013, plans must upload their LTC Utilization Pharmacy Utilization data file before they can supply the additional reporting elements via HPMS.

Studies suggest that copay programs reduce member cost-share and increase prescription adherence, which ultimately decreases overall medical spending. Not everyone agrees.

In April, CMS issued guidance containing significant reporting changes for Medication Therapy Management (MTM) programs. A key change is the modified definition in Section II, Element N – “Number of Prescriber Interventions”:

“Vitamin D for Fall Prevention” has been added to the list of preventative services and must be offered at zero dollar cost share for all plans as of January 1, 2014. Some pharmacy benefit management companies have added additional contraceptive agents (spermicides and female condoms) to the recommended list of women’s preventive services. And as of January 1, 2014, all plans will need to have the pharmacy preventive services (aspirin, iron supplements, fluoride, folic acid, smoking cessation, immunizations, Vitamin D, Women’s Preventive Services) covered at zero dollar copay.