Plan Benefit Package (PBP) CY 2021 Software Changes - HPMS

 
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Plan Benefit Package (PBP) CY 2021 Software Changes - HPMS
Plan Benefit Package (PBP)
CY 2021 Software Changes
PBP CY 2021 Training Agenda

Objective: Focus on CY 2021 Technical Changes

• Describe Key PBP Software Changes
• Describe Key MMP Changes
• Describe Key VBID/MA Uniformity Flexibility/SSBCI
  changes
• Describe Part D Payment Modernization Model
  Additions
PBP CY 2021
General Changes
PBP CY 2021 General Changes

• The Copy Plan (from Previous Year) function has been updated
  based on changes made to the PBP in the current year.
PBP CY 2021
Section A Changes
PBP CY 2021 Section A

• There were no changes to the PBP Section A for CY 2021.
PBP CY 2021
Section B Changes
Updated Section B – Cost-Share Limits

              Service Category                PBP Location    Voluntary MOOP    Mandatory MOOP
Inpatient Hospital – Acute - 60 Days          1a             N/A               $4,816

Inpatient Hospital – Acute - 10 Days          1a             $2,783            $2,226

Inpatient Hospital – Acute - 6 Days           1a             $2,524            $2,019

Inpatient Hospital Psychiatric - 60 Days      1b             $3,408            $2,726

Inpatient Hospital Psychiatric - 15 Days      1b             $2,339            $1,871

SNF-First 20 days                             2              $20/day           $0/day

SNF-Days 21-100                               2              $184/d            $184/d

Cardiac Rehabilitation Services               3              $50               $50

Intensive Cardiac Rehabilitation Services     3              $100              $100

Pulmonary Rehabilitation Services             3              $30               $30
Supervised exercise therapy (SET) for                        $30               $30
                                              3
Symptomatic peripheral artery disease (PAD)
Emergency / Post Stabilization Services       4a             $120              $90

Urgently Needed Services                      4b             $65               $65

Partial Hospitalization                       5              $55/day           $55/day
Home Health                                   6a             20% or $35        0% or $0

Primary Care Physician                        7a             $35               $35
Updated Section B – Cost-Share Limits 2

               Service Category                     PBP Location     Voluntary MOOP    Mandatory MOOP
Chiropractic Care                                  7b              $20                $20

Occupational Therapy                               7c              $40                $40

Physician Specialist                               7d              $50                $50

Psychiatric and Mental Health Specialty Services   7e & 7h         $40                $40

Physical Therapy and Speech-language Pathology     7i              $40                $40

Therapeutic Radiological Services                  8b              20% or $60         20% or $60

DME-Equipment                                      11a             N/A                20%

DME-Prosthetics                                    11b             N/A                20%

DME-Medical Supplies                               11b             N/A                20%

DME-Diabetes Monitoring Supplies                   11c             N/A                20% or $10

DME-Diabetic Shoes or Inserts                      11c             N/A                20% or $10

                                                   12              20% or $30         20% or $30
Dialysis Services
Part B Drugs-Chemotherapy                          15              20% or $75         20% or $75

Part B Drugs-Other                                 15              20% or $50         20% or $50
Section B-4

• Service Category B4 has been renamed to
  “Emergency/Urgently Needed Services” and the Benefit
  B4a has been renamed to “Emergency/Post-
  Stabilization Services.” The "Indicate Maximum per
  visit amount" question has had the cost-sharing
  validation implemented.
Section B-7

B-7j: Additional Telehealth
• The B7j Additional Telehealth Benefits question has been revised to
  read “Select the Medicare-covered benefits that may have Additional
  Telehealth Benefits available.”
B-7k: Opioid Treatment Program Services
• Service Category B7k has been renamed to “Opioid Treatment Program
  Services.”
Section B-13

• The notes for B13d, B13e, B13f and B13g (when they
  are applicable) will now be required when the benefits
  in these sections are offered.
Section B-14

B-14c: Other Defined Supplemental Benefits
• A mandatory question has been added to indicate type of Fitness
  Benefit offered for the B14c4 Fitness Benefit category.
• The B14c8 benefit category name has been changed to "Home
  and Bathroom Safety Devices and Modifications."
Sections B-15 and B-20

• "Medicare Part B Chemotherapy Drugs" has been
  changed to "Medicare Part B Chemotherapy/Radiation
  Drugs.”
PBP CY 2021
Section C Changes
Section C

• Section C – Plans can now offer Remote Access
  Technologies in OON or POS even if not offered in B14c but
  B7j is offered in section B.
• Section C – Plans can no longer select 14e6 Other Medicare
  Covered Preventive Services in Section C if there is no
  B14e6 data entered in Section B.
• Section C OON and POS groups– Plans are now required to
  enter a note if a copay and coinsurance is offered OR a
  range in either copay/coinsurance is entered.
• The OON and POS Medicare service category picklists have
  been updated to remove B7j Additional Telehealth.
PBP CY 2021
Section D Changes
Section D – Continued 1

• Combined Benefits screens have been added to allow
  plans to combine supplemental benefits into up to
  three groups. These screens will allow the plan to offer
  groups of supplemental benefits together with a single
  maximum plan benefit amount and will also require the
  plan to designate if the enrollee must select one or
  more of the benefits (as opposed to having access to all
  of the combined benefits selected).
   • Note: If the plan offers combined benefits in these
      screens, the plan must first offer them in Section B.
      Each benefit may only be offered in one combined
      supplemental benefit package.
Section D – Continued 2

• Part C Reductions in Cost Sharing (RICS) screens have
  been added for plans to enter reduced cost sharing for
  A/B and/or supplemental benefits in the base bid
  (applicable to all enrollees unlike Section 19 which are
  benefits offered to unique populations).
• Plans can now select 19a or 19b in the Non-Medicare
  covered picklists for plan-level MOOP.
• B7j Additional Telehealth has been removed from
  Optional Supplemental benefits picklists.
PBP CY 2021
Section Rx Changes
Section Rx

• The validation requiring that the retail 3-month day
  supply value must be the same across all offered tiers
  has been removed. The range must still be between 90
  and 102 days, inclusive.
• Language updates were made throughout the section
  to clarify and simplify the terminology.
• Section Rx data entry screens have been updated.
Medicare-Medicaid Plans
 CY 2021 PBP Changes
MMP – PBP (Section Rx)

• The edit rules for maximum cost-sharing amounts for MMPs drug
  tiers have been updated as follows:
    • For a Generic only tier: The Maximum allowable copay is
      $3.70.
    • For a Brand only tier: The Maximum allowable copay is $9.20.
    • For a Non-Medicare drugs only tier: No validations.
    • For a Combination (Brand & Generic) tier: The Maximum
      allowable copay is $9.20.
    • For a Combination (Medicare & Non-Medicare drugs) tier:
      The Minimum and Maximum copay must both be $0.
VBID/UF/SSBCI
CY 2021 PBP Changes
VBID/UF/SSBCI – PBP (Section B-19)

• An option for VBID plans to offer a VBID Hospice benefit has been added.
  Screens to capture these benefits have been added in B19c.
• A screen for VBID plans to outline the components of their Wellness and
  Health Care Planning (WHP) programs offered to enrollees has been
  added.
• On the B19a and B19b Package Information screens, the prerequisite
  question option has been changed “participation in a wellness or care
  management program” to “participation in a care management program.”
• The list of other VBID interventions (in addition to WHP) for selection in
  B19a and B19b has been revised to “Value-Based Design Flexibilities by
  Condition or Socioeconomic Status” and “Medicare Advantage Rewards
  and Incentives Programs.” “Telehealth Networks” has been removed from
  the list of interventions.
VBID/UF/SSBCI – PBP (Section B-19) – Continued 1

• New VBID Rewards and Incentives screens have been added.
• An on-screen label has been added instructing users to go to Section Rx to
  enter VBID Part D Rewards and Incentives.
• The notes fields required for VBID packages offering Medicare Advantage
  Rewards and Incentives Programs or Telehealth Networks have been
  removed.
• The 19a and 19b VBID Disease State screens have been renamed to be
  VBID Target Population screens. The questions on these screens have been
  updated to separate chronic condition(s) from socioeconomic status in
  specifying targeting methodology and to gather additional information on
  disease state requirements as well as estimated enrollees to be targeted
  and engaged to receive model benefits. The questions “Does the enrollee
  need to have all diseases selected to qualify? Y/N” and “Does the enrollee
  need to have a combination of diseases selected to qualify? Y/N” have
  been added to these screens for all VBID packages.
VBID/UF/SSBCI – PBP (Section B-19) – Continued 2

• In Section 19b, 13i the benefit “Transitional/Temporary
  Supports” has been renamed “General Supports for Living.”
• In Section 19b, PPO plans are required to select "Yes" to the
  question "Do the benefits in this package apply to OON/POS?"
VBID – PBP (Section Rx)

• New Part D Rewards and Incentives screens have been
  added.
• The questions on the VBID Package Setup screen have
  been updated to separate chronic condition(s) from
  socioeconomic status in specifying targeting
  methodology and to gather additional information on
  estimated enrollees to be targeted and engaged to
  receive model benefits.
• The question “Is any of the cost-sharing reduction
  contingent upon participation with a high-value
  pharmacy network?” has been removed from the
  VBID Package Setup screen.
Part D Payment Modernization

• The PBP software has been updated to include new
  screens for Part D Payment Modernization Model
  plans to describe their model flexibilities.
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