skip to Main Content

April 2017 Compliance Insights

April 2017 Compliance Insights

IMPORTANT REMINDERS

April 3, 2017 Release of the 2018 Final Announcement of Medicare Advantage Capitation Rates and MA and Part D Payment Policies, including the CY 2018 Call Letter. For an overview of the Call Letter, see our recent blog.

April 21, 2017 Final 2017 Medicare Parts C and D Program Audit Protocols announced. See Compliance News section for details

April 28, 2017 Final 2017 Program Audit Pilot Protocols for Medicare-Medicaid Plans (MMPs).

May 2017 Final ANOC/EOC, LIS rider, Part D EOB, formularies, transition notice, provider directory, pharmacy directory, and MMP models for CY 2018 available for all organizations

May 2017 Medicare Advantage & Prescription Drug Plan Spring Conference & Webcast

May 26, 2017 Release of the CY 2018 Marketing Module in HPMS. Plans/Part D sponsors begin to submit 2018 marketing materials

Late May/Early June, 2017 Release of the CY 2018 Medicare Marketing Guidelines in HPMS

October 1, 2017 Additional questions to be included in the Health Risk Assessment to help identify members who may benefit from Long Term Services and Supports (for California Medi-Cal operating in CCI counties and Cal MediConnect). See Compliance News section for details

COMPLIANCE NEWS

Final 2017 Medicare Parts C and D Program Audit Protocols

On April 21, 2017, CMS announced the final 2017 Medicare Parts C and D Program Audit Protocols (CMS-10191) and posted them to the CMS website. The Medicare Parts C and D Oversight and Enforcement Group (MOEG) highly encourages the industry to review these protocols, including the data and documentation requests, in preparation for future audits. Organizations are expected to fully comply with the audit protocols and the associated data collection efforts. To view the protocols, please go to the CMS website.

A review of the final Protocols against the October 2017 draft Protocols shows limited changes. MedHOK is in the process of finalizing the Universe Audit reports with our clients and making them available in the reporting module.

Non-discrimination in Health Programs and Activities (45 CFR Part 92)

We would like to address the importance of the final rule implementing the Affordable Care Act (ACA) (Section 1557). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. This rule shifts the priority from the top 15 languages nationally to the top 15 languages in a plans’ given state(s).

Based on the final rule, MedHOK strongly recommends plans review their letters and ensure the required taglines are present in at least the top 15 languages spoken by limited English proficient populations statewide as identified by the Office of Civil Rights (OCR).

Section 1557 states, “In addition, with respect to the obligation in § 92.8 to post taglines in at least the top 15 languages spoken nationally by persons with limited English proficiency, OCR has replaced the national threshold with a threshold requiring taglines in at least the top 15 languages spoken by limited English proficient populations statewide.” The state list can be found here.

The OCR invited comment to the rule and responded to these comments regarding the tagline requirement. Page 31398, in short, states the following “Posted taglines sufficiently alert individuals to the language assistance services available and appropriately balance the educational value of the notices with the burdens to covered entities. Given that we are not requiring covered entities to post notices in non-English languages, having taglines available in multiple languages is even more important to provide notice to individuals with limited English proficiency of the availability of language assistance services. Thus, we decline to reduce the number of languages in which taglines are required to appear, even for covered entities operating in smaller physical spaces.” They further go on to say “We decline to eliminate the tagline requirement because such an approach would not provide adequate notice of language assistance services.

DHCS issues guidance on additional questions to be included in the Health Risk Assessment by October 1, 2017, to help identify members who may benefit from Long Term Services and Supports

To strengthen the coordinated care initiative and Cal MediConnect. the Department of Health Care Services (DHCS) has released the draft All Plan Letters (APL) outlining additional proposed requirements for the Health Risk Assessments (HRA).. A key area of the DHCS initiative was improving referrals to Long-Term Services and Supports (LTSS), ensuring beneficiaries who could benefit from LTSS were, in fact, connected to those programs. A dynamic work group comprised of various stakeholders addressed how best to improve the effectiveness of referrals to LTSS and in February 2017 DHCS released the “Cal MediConnect HRA Workgroup: Summary of Recommendations.

The group’s recommendation to help address a comprehensive set of beneficiary risk factors was used as a basis for the formal APL guidance released to the Cal MediConnect and Medi-Cal managed care plans. The 10 risk-based questions outlined in the APL are divided into four categories (social determinants, functional capacity, medical conditions and behavioral health conditions) and 2 tiers. When viewed holistically, these questions help identify members needing a follow up assessment relative to LTSS services. The DHCS draft APL asks that all new questions are incorporated into managed care plans’ HRAs and utilized by October 1, 2017.

The draft APLs can be found below. Questions to be included within the HRA are outlined in the attachment document following the letter.

MedHOK will continue to monitor for the release of the final APL as well as work with our clients who will need to meet this proposed deadline.

SECURITY NEWS

Warning! Don’t Click that Google Docs Link You Just Received in Your Email

Did someone just share a random Google Doc with you? Do not click on that Google Doc link you might have just received in your email and delete it immediately — even if it’s from someone you know.

Once you click the link, you will be redirected to a page that says, “Google Docs would like to read, send and delete emails, as well access to your contacts,” asking your permission to “allow” access. If you allow access, the hackers would immediately get permission to manage your Gmail account with access to all your emails and contacts, without requiring your Gmail password.

But how? The “Google Docs” app that requests permissions to access your account is fake and malicious. It is created and controlled by the attacker. You should know that the real Google Docs invitation links do not require your permission to access your Gmail account.

This Google Docs phishing scheme is spreading incredibly quickly, hitting employees at multiple organizations and media outlets that use Google for email, as well as thousands of individual Gmail users who are reporting the same scam at the same time.

If by chance you have clicked on the phishing link and granted permissions, you can remove permissions for the fraudulent “Google Docs” app from your Google account. Here’s how:
Go to your Gmail accounts permissions settings at https://myaccount.google.com and Sign-in.

  1. Go to Security and Connected Apps.
  2. Search for “Google Docs” from the list of connected apps and Remove it. It’s not the real Google Docs.

Swati Khandelwal,(2017, May 3) “Warning! Don’t Click that Google Docs Link You Just Received in Your Email” http://thehackernews.com/2017/05/google-docs-phishing-email.html

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

Back To Top