1. Part D Outcomes Enrollment

2. Agenda 2017 Pilot Lessons 2018 Cost Change Data
Complete Enrollment Contacts
Draft Quality Assurance Process
Resources

3. Pilot Lessons 11 states, 2-6 months of participation
45,993 eligible records
70% with complete cost data
Multiple fields caused confusion (Drug list ID, password date, notes, before and after costs)
Cost changes report between
$9,951,414,719 to -$10,911,201,205,031,800

4. Complete Enrollment Outcome Contact Elements
Enrollment Box
Enrollment box is checked as a subtopic for either:
Medicare Part D, or
Medicare Advantage  
2. Plan Costs
Plan costs in the Special Use Fields (SUF) are numeric, and greater than $0”:
Original PDP/MAPD Cost, and
New PDP/MA-PD Cost  
3. Verifications
Verification documentation attached or attest it’s on file:
Plan Comparison page from the Medicare Plan Finder (MPF), and
Documentation to verify the Enrollment Request. 

5. Verification Documentation
All dollar amounts reported in the performance measures for cost avoidance and savings must have supporting documentation for each individual case.
Tried Drug ID List and Password aren’t sufficient and not in new MCT
MPF or with Watermark not available in MCT either
In OIG reporting, the same dollar amount cannot be counted under more than one measure.
Good example of why not including MSP and LIS amounts since counted as part of MIPPA to a great extent.
Not many but some concern at duplicate entries of savings information or Part D enrollments vs. comparisons.
OIG is looking for the pages that show the original and revised dollar amounts – cite file names and page #s in explanation box.
SMPs upload documentation into SIRS, same platform as STARS, and write notes explaining the documents and the dollar amounts.
Documents should clearly provide the beneficiary’s name, service date, service(s) provided, and dollar amounts.
Written notes of the counselor/volunteer are helpful but not considered sufficient evidence
Plan Finder comparison PLUS enrollment confirmation screenshot or scanned images are acceptable and do not provide HIPAA concerns.

6. Apr – Dec 2018 Cost Change Data
Advanced Search for BCF/BAS any entry in SUF1
96,475 any value in SUF Field 1
2,984 removed from list
2,823 $0 only (many API)
161 nonnumeric text
9,490 dollar value >$1 yet enrollment not marked
85,289 total PDP/MA-PD enrollments
6,631 MAPD enrolls
78,658 PDP enrolls
1,288 marked combo of more than one Enrollment
 Too early to share results publicly
85,289 Enrollments
6,631 MAPD enrolls
78,658 PDP enrolls
1,288 marked combo of more than one Enrollment

7. Quality Assurance Needs
Nonnumeric value in SUFs
Enrollment box selection
API mishaps
Threshold
Duplicate cost change reporting
Verification documentation

8. QA Process Step 1 Cost Change report contains
Two cost change reports annually from ACL
February report will cover August to January
August report will cover February to July
Cost Change report contains
Contacts for the six month time frame
Indicates valid and flagged contacts

9. Step 2 Timing SHIP reviews, verifies, and edits cost change contacts
By Mar. 30: February report covers August to January
By Sept. 30: August report covers February to July
Confirm 5% of valid contacts have both
Plan comparison from MPF with cost amounts
Enrollment request in STARS or available in paper or electronic files
Review and edit all flagged contacts

10. Step 2 Valid and Flagged Contacts
Valid contacts
Enrollment box checked, and
SUF cost data is numeric and greater than $0
Flagged contacts
Incomplete or missing data,
SUF cost data are nonnumeric or $0
Both PDP and MAPD enrollment boxes are selected, or
Cost change amounts outside the threshold

11. Common Enrollment Box Flags
Edits
Cost data in SUFs, enrollment box not checked. Cost data reported and verification documentation uploaded.
Check appropriate MA-PD or PDP enrollment box.
Enrollment box not checked, missing verification documents. Enrollment box not checked and required verification documents missing.
If verification documentation is available, check enrollment box and upload documents (or attest it is on file). If verification documentation is not available, remove cost data from SUFs.
Enrollment boxes checked for PDP and MA-PD. Beneficiary enrolled into one plan yet both the PDP and MA-PD enrollment boxes are selected.
Review verification documents and select one appropriate enrollment box. NOTE: During OEP, two enrollments may occur in one counseling session, selecting both enrollment boxes is appropriate in this situation only.
No enrollment with SUF Text Issues. No enrollment completed AND non-numeric text entered in SUFs.
Remove text data from cost SUFs.

12. Common Verification Documentation Flags Edits
Verification documentation not uploaded API. Documentation not uploaded into STARS due to API or non-Medicare Plan Finder (enrolled by phone, plan website, etc.)
SHIP stores verification documentation outside STARS and attest to it.
Verification documentation does not exist. Enrollment completed AND both required verification documents do not exist.
Remove cost data from SUFs. This applies to API and direct entry states.
Verification documentation is incomplete. Enrollment completed, but either the plan comparison or enrollment request form is missing.
If available, upload or attest paper or electronic files are available. If unavailable, remove cost data from SUFs (applies to API and direct entry).

13. Threshold. Record outside the defined cost change threshold.
Common SUF Flags
Edits
Cost data not reported in SUFs. Enrollment box checked AND verification documentation has been uploaded.
Enter cost data in SUFs as shown on plan comparison page.
Threshold. Record outside the defined cost change threshold.
Verify cost data and verification documentation.
Enrollment with SUF Text Issues. Enrollment completed, but non-numeric text entered in SUFs.
Enter cost data from plan comparison in cost SUFs.
Duplication. More than one BCF contains the same Original and New PDP/MA-PD SUF costs.
Verify cost data, enrollment, verification documentation and remove cost data for duplicative BCFs.

14. Records <15k and > -5k
Step 2 Threshold
Setting thresholds
Entry errors: saved $200,742,988 to cost $330,596,694 more
Bell curve
Ideas?
Records <15k and > -5k
BCFs
Mean
$7,469.69
Standard Deviation
$3,150,138.55
1 Std Dev (68.2%)
-$3,142,668.86 5
$3,157,608.24 11
2 Std Dev (95.5%)
-$6,292,807.41 2
$6,307,746.79
3 Std Dev (99.7%)
-$9,442,945.96 1
$9,457,885.34 9
Entry errors: saved $200,742,988 to cost $330,596,694 more
Bell curve – might be because we used Original Medicare costs for people without coverage or those changing from some other coverage
Other ideas?

15. Step 3 SHIP Training
STARS manual Chapter 4 Beneficiary Contacts pages 20-26
SHIP TA Resource Library
Incorporate Enrollment Outcomes reporting in counselor training
Target retraining efforts to flagged list frequent fliers
Other needs?

16. Step 4 Cost Change Attestation
Complete the SHIP Part D Enrollment Outcomes Attestation to certify the SHIP QA process is complete
By March 30th for February report
By September 30th for August report
the attestation to the SHIP box
Draft form next slide

18. Step 5 National Random Sample
ACL will randomly sample a minimum of 5% of the Enrollment Outcome contacts
ACL will move cost change data for any records deemed incomplete
Move cost change data to the notes section b/c don’t want ACL to be deleting data from the system.

19. Records Retention Grantee record retention policy
Retain all documentation for a grant for a minimum of three (3) years after the submission of the final report
Current SHIP Grant Example
Grant ends 3/31/2020
Final report due on 7/1/2020
Maintain grant documentation to 7/1/2023.

20. Feedback and Ideas
Submit additional comments, concerns, and ideas to the SHIP mailbox