January 26, 2007
The Centers for Medicare & Medicaid Services (CMS) updated 2007 Medicare Part D reporting requirements to ensure a "common understanding" of CMS' data reporting provisions. The update is designed to meet CMS' obligations under the MMA to ensure each Part D Plan Sponsor provides data for statistics that indicate: (1) cost of its operations; (2) patterns of utilization of its services; (3) availability, accessibility, and acceptability of its services; (4) information demonstrating it has a fiscally sound operation; and (5) other matters as required by CMS. The document details current expectations of data elements that Plan Sponsors must provide for their Part D contracts. The update also sets forth reporting timeframes and monitoring processes of Part D contracts. Additional reporting requirements will be identified in separate guidance documents throughout the year. Non-compliance with these reporting requirements could trigger sanctions as outlined in Subpart O of the Part D Rule (42 C.F.R. Part 423).
The reporting requirements identified in the document include the following: (1) submission of licensure and financial solvency data; (2) rate of generic drug utilization; (3) pharmaceutical manufacturer rebates, discounts, and other price concessions; and (4) medication therapy management programs. The reporting requirements also include the submission of long term care (LTC) rebate data, customer service call center data, and data that demonstrates that Part D contracts have an effective transition process to ensure that beneficiaries transitioning into a Plan are provided a smooth transition to drugs in the formulary.
For more information, read the full report, Medicare Part D Reporting Requirements, Contract year 2007.
We would like to thank Greg Ewing (Sutter Health, Sacramento, CA) for providing this email alert.
The Medicare Part D Task Force is a joint endeavor of the Fraud & Abuse, Self Referrals, and False Claims; Health Information and Technology; HMOs and Health Plans; Life Sciences; Long Term Care; Regulation, Accreditation, and Payment; and Teaching Hospitals and Academic Medical Centers Practice Groups.