1 HPMS Bid Submission & PBP 2013 Don Freeburger, Lucia Patrone, & Sara Silver HPMS Analysts

2 Agenda Key Bid Submission Dates Bid Upload Requirements HPMS Access PBP 2013 High Level Changes

3 Key 2013 Bid Submission Dates

4 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)

5 Bid Upload Requirements

6 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

7 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)

8 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

9 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:

10 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)

11 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

12 HPMS ACCESS Obtaining a CMS / HPMS User ID HPMS Login Process Maintaining HPMS Access

13 Applying for HPMS Access Download a copy of the Application for Access to CMS Computer Systems form at: ssform.pdf 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

14 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: C Baltimore, MD 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

15 HPMS Login Process 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

16 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

17 HPMS Login Process HPMS Home Page

18 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 s Link for completing certification online/changing password

19 Annual Certification Process Online or Manually Online at Manually by submitting access form

20 Certification Notification >From: >Sent: Wednesday, March 21, :44 AM >To: Freeburger, Don (CMS/CPC) >Subject: 11 Day Warning for CMS Certification - ACTION > >Lucia >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 >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 > > (for CMS internal users) > or > (for external MDCN users) > or > (for Internet users) > >NOTE: Please use Microsoft Internet Explorer 7.0 or above when accessing EUA >Passport. > >and it must be approved by:

21 Online Certification Process

22 Online Certification Process Enter User ID and Password to Login

23 Online Certification Process Enter User ID and Password “Again” to Login

24 Online Certification Process

25 Plan Benefit Package (PBP) and Summary of Benefits (SB) CY 2013 Software Changes

26 PBP 2013 Training Agenda Objective: Focus on CY 2013 Technical Changes Describe Key PBP CY 2013 Software changes Describe Key SB CY 2013 Changes

27 PBP CY 2013 Section A Changes

28 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

29 PBP CY 2013 Section B Changes

30 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 Hospital- Acute) 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

31 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”

32 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

33 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

34 PBP 2013 Section C Changes

35 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 Non- Medicare-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

36 PBP 2013 Section D Changes

37 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-of- Network The plan cannot offer a separate In-Network or Out-of- Network Deductible The plan may exclude from the combined deductible any In- Network Medicare-covered service The MOOP questions have been updated as follows: Plans select the services that are included in a given MOOP

38 PBP 2013 Section Rx Changes

39 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

40 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

41 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%

42 Summary of Benefits CY2013 Changes

43 Summary of Benefits – General The phrase "Medicare-covered Zero Cost-Sharing Preventive Services" has been revised to "Medicare- covered 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

44 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

45 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?”

46 PBP/SB Contacts PBP Software Technical Issues: –Sara Silver –Lucia Patrone PBP/HPMS Technical Help Desk: –Help Desk MA Benefit Operations & Policy Issues (MA PBP): –MA Benefits Mailboxhttps://MABenefitsMailbox.lmi.orghttps://MABenefitsMailbox.lmi.org –Marty Abeln –Russell Hendel (Policy) –Heather Hostetler MA Marketing Operations & Policy Issues (MA SB): –Elizabeth –Melissa Part D Benefit Operations & Policy Issues (Part D PBP): –Kathleen –Rosalind –Frank Part D Marketing Operations & Policy Issues (Part D SB): –Rosalind –Lisa