PACE, MAP, and Medicare Advantage

PACE, MAP, and Medicare Advantage Guidance for PACE and Part D Sponsors on COVID-19 Prescription Antivirals: The guidance is intended to ensure that claims for oral antivirals are processed appropriately to serve the goals of ensuring beneficiary access to these medications at no cost sharing for as long as possible and utilizing supply that has already been procured by the U.S. government.
January 16, 2024

PACE, MAP, and Medicare Advantage DOH Finalizes Supplemental PACE Rates: Revised April 2023 Medicaid rates reflect minimum wage increases, as well as hospital, nursing home, and behavioral health rate updates.
January 9, 2024

PACE, MAP, and Medicare Advantage Medicare Advantage Regulations Impose Limits on Utilization Management: Key provisions of the regulations take effect on Jan. 1, 2024 and require Medicare Advantage coverage decisions to be no more restrictive than fee-for-service Medicare, limit the uses of prior authorization, and require physician-ordered sites of service to be honored.
December 18, 2023

PACE, MAP, and Medicare Advantage Proposed Medicare Advantage and PACE Regulations Offer Additional Beneficiary Protections: On Nov. 6, 2023, CMS posted a proposed rule that would revise the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, PACE, and certain health information technology standards. The proposed regulations are intended to strengthen beneficiary protections and ensure that Medicare Advantage plans meet the needs of beneficiaries.
November 13, 2023

PACE, MAP, and Medicare Advantage CMS Issues Various Memos for Medicare Advantage and PACE Plans: Plans should preview their 2024 "Medicare and You" Handbook data and verify their HPMS crosswalk data for accuracy and completeness.
August 7, 2023

PACE, MAP, and Medicare Advantage DOH Prepares PACE Program Payments: Initiative backed by enhanced federal HCBS funding is aimed at supporting and growing PACE.
June 6, 2023

PACE, MAP, and Medicare Advantage Updates to PACE Quality Reporting and Monitoring Forthcoming: CMS updates quality reporting requirements for PACE and Medicare Advantage for 2024 and notifies PACE organizations of upcoming changes to the Quality Monitoring module.
May 16, 2023

PACE, MAP, and Medicare Advantage PACE Programs Encouraged to Register for April 27th CMS User Group: CMS officials to review 2024 Rate Announcement and recent HPMS Memos, demonstrate risk score calculations, and answer questions.
April 11, 2023

PACE, MAP, and Medicare Advantage CMS Finalizes Medicare Advantage, PACE, and Part D Policy Regulations: The final rule includes new provisions for MA utilization management and prior authorization, behavioral health access, and MA plan Star Ratings. For PACE programs, it includes new provisions governing CMPs, contracted specialists, oral service determination request extensions, and maintenance of records.
April 10, 2023

PACE, MAP, and Medicare Advantage Distribution of eFMAP Funding to PACE Programs Detailed: $40 million will be distributed to nine PACE organizations as lump sum payments for workforce, reopening and infrastructure, and expansion.
March 7, 2023