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PACE Organizations: Register for CMS Call on Risk Adjustment Submission Changes by June 7th

(June 4, 2024) The Centers for Medicare and Medicaid Services (CMS) has scheduled a Program of All-Inclusive Care for the Elderly (PACE) User Group Call for 2 p.m. on June 13th to discuss risk adjustment data submissions. The call will provide an overview of the technical instructions for submitting risk adjustment data to the Encounter Data System (EDS) and review EDS processing for PACE organizations. CMS will review submission examples and offer a question-and-answer session to address submission scenario questions. Members will recall that the transition from the Risk Adjustment Processing System (RAPS) to EDS for the submission of risk adjustment data for services provided in the PACE center generated many questions.

Registration, available here, requires the entry of a valid contract ID and is limited to PACE organizations, third-party submitters, and technical partners supporting PACE organizations. Please note that you must register no later than June 7thThe event flyer is available here. The Jan. 29th letter from the Medicare Plan Payment Group on risk adjustment submissions to the EDS is here. The Encounter Submission and Processing Guide is available here, and the CMS Customer Service and Support Center website that contains information and resources about Medicare Parts C and D is here.

In addition, we remind PACE organizations that in the June payments, CMS will be recouping overpayments of Part D add-ons paid from January 2023 to May 2024. During that period, CMS erroneously double-paid the dual eligible low-income premium subsidy amounts. The add-on amounts will also be corrected starting in June. The corrected amounts can be accessed as follows: HPMS Home:-- Plan Bids:-- Bid Submission:-- CY yyyy:-- Review Plan Data:-- Contract Number:-- Part D Bid and Payment Amounts. The associated letter, dated May 15th, is available here.

Finally, on the state side, we want to share that the Department of Health (DOH) has confirmed that PACE organizations will not be subject to the carve-out of Consumer Directed Personal Assistance Services (CDPAS) Fiscal Intermediary (FI) administrative costs from their premiums. Members will recall that DOH recently announced that effective July 1, 2024, funding for FI administrative costs would be removed from the monthly plan premium and paid on a managed fee-for-service (FFS) basis with FIs billing plans, plans billing the tiered FFS schedule through newly established rate codes, and then passing the exact amount back to the FI. This July change will not impact PACE.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841