Medicare Parts C and D Data Validation Trends and Challenges October 29, 2013 Presented by:

1. Medicare Parts C and D Data Validation Trends and Challenges October 29, 2013 Presented by: Jim Casurella Rob Shelley Sadie Zarnoth

2. Today’s Agenda Disclaimer: Off-season we are restricted by CMS from “consulting”. We can’t answer your specific questions about measures, but we can pass them along to CMS and share with you their response.

3. 2013 Data Validation HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

4. 2013 Data Validation

5. 2013 Data Validation Disclaimer: These statistics were excerpted from CMS Memo dated August 2, 2013, subject line was “Results of the 2013 Part C and D Reporting Requirements Data Validation”.

6. 2013 Data Validation Disclaimer: These statistics were excerpted from CMS Memo dated August 2, 2013, subject line was “Results of the 2013 Part C and D Reporting Requirements Data Validation”.

7. 2013 Data Validation • Challenging Standards • Standard 1g: Recalculation narrative that matches the process • Standard 1g: Keep manuals, policies, and procedures updated • Standard 1g: Consolidationand centralize documentation • Standards 2d and 2e: Consistentcategorization to data elements • Standard 3a: Quality assurance process for data entry to ensure accuracy • Standard 7: Sufficient oversight of all vendors • Various Standards: Continuous training For current DV specifications and documentation, go to cms.gov

8. 2014 Data Validation Contract Year 2013 Measures • Two Part C measures from Contract Year 2012 will also be validated in this year’s cycle.

9. 2014 Data Validation • 2014 Changes • Part C • No validation of Plan Oversight of Agents for Part C or Part D • Serious Reportable Adverse Events (SRAE): Validating two years rather than one • Special Needs Plan (SNP): Validating two years rather than one

10. 2014 Data Validation • 2014 Changes • Part D • Grievances Part D: Plan submits once instead of four times; two additional data elements validated • Coverage Determinations/Exceptions: Plan submits once rather than four times; number of data elements increased to 29 • Redeterminations: Plan submits once rather than four times • Long-Term Care Utilization: Two files instead of previous three (one year instead of two) • Medication Therapy Management Programs (MTMP): Increased from 19 to 26 data elements

11. 2014 Data Validation • StandardsValidation • CMS is available for questions. • Source data must be available! • The 2014 Data Validation Manual and Appendix B, the Data Validation Standards must be used to evaluate your practices.

12. Can It Be Automated?

13. What’s on the horizon?

14. In Closing… Rob Shelley rshelley@psrx.com Amanda Throm athrom@psrx.com

15. Providing Informed Pharmacy Decisions