Medicare Advantage & Part D Regulatory Reporting Updates
Medicare Advantage plans need an effective procedure to develop, compile, evaluate and report information to the Centers for Medicare and Medicaid Services (CMS) in the time and manner that CMS requires. Organizations contracted to offer Medicare Part C and Part D benefits are required to report data to CMS on a variety of measures. CMS has developed reporting standards and data validation specifications with respect to the Part C and Part D reporting requirements. These standards and specifications provide guidance on the data validation process for Medicare Advantage plans, cost plans, and Part D sponsors used to conduct data validation checks on their reported Part C and Part D data.
The technical specifications for the reporting requirements provide a description of the measures, reporting timeframes and deadlines, and specific data elements for each measure.
CY 2021 Part C Reporting Requirements
CMS releases the reporting requirements and technical specifications document of Part C and Part D on an annual basis. This year “Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR” for the year 2021 was released on June 22, 2020 and can be found on the CMS website.
Changes to the 2021 Part C Reporting Requirements
- “Data Element B: If yes, list the number of specialty providers that offer Additional Telehealth benefits” has now changed to “Data Element B: If yes, enter the number of Medicare Part B provider specialty types for which Additional Telehealth Benefits are covered.”
- Data Element C: If the organization offers additional telehealth benefits, they should report the list the Medicare Part B provider specialty for which additional telehealth benefits are offered. These may include:
- Primary care
- Allergy and immunology
- Gynecology, OB/GYN
- Infectious diseases
Elements Deleted in 2021 Part C Reporting Requirements
If the MA plan offers additional telehealth benefits, it does not need to report on the following data elements going forward:
- Data Element D: List the county and state for each telehealth specialty has been discontinued. If a telehealth provider serves enrollees from multiple counties in the service area, then count the provider multiple times with the appropriate state and county.
- Data Element E: Total number of contracted telehealth providers per contract.
- Data Element F: Total number of contracted in-person providers for this specialty in this county and state. The deletions are made to improve the accuracy of the reporting.
- Data Element G: How many of these contracted providers offer both in-person and telehealth within the same contract?
CY 2021 Part D Reporting Requirements
“Medicare Part D Reporting Requirements and Supporting Regulations in MMA Title I, Part 423, §423.514” for the year 2021 is available on the CMS website.
These rules will revise regulations for the Medicare Advantage (MA or Part C) program, Medicare Prescription Drug Benefit (Part D) program, and Medicare Cost Plan program to implement certain sections of the Bipartisan Budget Act of 2018 and the 21st Century Cures Act. In addition, it will enhance the Part C and D programs, codify several existing CMS policies, and implement other technical changes.
Part C and Part D reporting requirements mentioned above will be effective beginning Jan. 1, 2021.
There are no changes to the Part D requirements, except for the addition of regulation section numbers to provide technical clarification.
Medicare Part C and Part D Program Audit Protocols (2020): Part C Organization Determinations, Appeals and Grievances (ODAG) and Part D Coverage Determinations, Appeals and Grievances (CDAG) Audit Protocols were released by CMS in June 2020. The most significant change is the replacement of “Cardholder ID” with “Enrollee ID” in all the tables of both reports. Additionally, CMS has revised its language in a few tables. These latest and updated protocols are of version v. 6-2020, with OMB Control Number 0938-1000 having an expiration date June 30, 2023. The CMS availability of these audit protocols is available here.