CY 2013 Plan Benefit Package (PBP) Software
Contents
1. Basic PBP 2013 Data Entry and Functionality Section Rx Medicare Rx General Screen 1 Required Data Entry Type of drug benefit 4 Types All demonstration plans must be Enhanced Alternative plan types because you must offer full gap coverage and most demonstration plans will offer excluded drugs through a supplemental Part D benefit Components of pharmacy network Financial Alignment Demo Plans must NOT select a Preferred Non Preferred structure for retail or mail order pharmacies The locations selected here must agree with the locations selected on the Tier Locations Screen s or the General Location Supply Screen Ju Gus National prescription coverage COAT fer MERCY 4 Um Alternative Deductible Enhanced Characteristics Screen Plans must indicate No Deductible when completing data entry in the PBP e Plans should answer Yes to offering reduced Part D cost sharing All demo plans offer a reduced deductible e Only answer Yes to the excluded drug question if your plan is offering Part D excluded drugs All demo plans must answer Yes to offering Additional Gap Coverage ly b v T i CATS h CENTERS fue MPEROUM A key du Alternative Characteristics Screen BP Data Entry System Section Contract File Help lt lt Previous Next gt gt Exit Validate Exit No Validate2. Service Category Indicate Maxi Coi tage for Medicare d Benefits Is there service specific Maximum Enrollee Out of Pocket Cost re en u oos siste i e Label Yes No Is there an enrollee Deductible Indicate Maximum Enrollee Out of Pocket Cost amount Indicate Deductible Amount Select the Maximum Enrollee Out of Pocket Cost periodicity C Every three years C Every two years C Every year ree C Every six months No Every three months C Other Describe Is there an enrollee Copayment Indicate Minimum Copayment amount per visit for Medicare covered Benefits Indicate Maximum Copayment amount per visit for Medicare covered Benefits CATS COTW fer 4 FTE Urn Section B Data Entry Continued 6 Authorization Enrollee Provider must obtain approval from plan prior to receiving service benefit 7 Referral Enrollee must obtain approval before receiving more specialized services 8 Optional Notes Only use to describe benefits NOT clearly defined in the PBP data entry screens 6 v T z 4 CAZS v 4 iva COAT MORO 4 Unna Section B 13H Additional Services This additional data entry screen is available in the April 20 PBP Patch Use this data entry to only include Medicaid covered benefits Only select the services that apply Both in network AND out of netwo
3. 4 SFE Urn General 3 Screen Indicate the same number of tiers as the formulary submitted in April 2012 Indicate Exceptions Tier Tier Model Screen Choose labels for every tier Please ensure the tier model selected in the PBP matches the tier model in the formulary REMINDER Deadline to submit new formularies is April 30 2012 Please ensure you have completed the formulary contact information in HPMS to receive appropriate communications HPMS gt Contract Management gt Basic Contract Management gt Select Contract Number gt Contact Data gt Formulary Contact of WEALT 4 CAVES CONTR fe MPERCAAN 4 rt atk 3 rasa Tier Type and Cost Share Structure screen Tier Drug Type s Allowable selections based on tier labels chosen on the Tier Model screen Tier Includes Part D Drugs and or Excluded Part D drugs Indicate type of cost sharing structure for the tier Alternative Pre ICL Cost Sharing o For demo plans offering LIS cost sharing amounts Indicate Medicare defined Part D coinsurance amount o For demo plans buying below LIS cost sharing for one or more tiers Indicate Cost Share Tiers if a subset of tiers are being bought below LIS or No Cost Sharing if ALL tiers are 0 cost sharing Enter the applicable cost sharing that is BELOW the LIS value e g if you offer a tier at 0 copay Enter the LIS
4. Do you offer reduced Part D cost sharing as part of your supplemental Part D Benefit C Yes C No Indicate the area s throughout the Part D benefit where the reduced Part D cost sharing is reflected select all that apply Reduced deductible Reduced pre ICL cost shares Raised ICL Reduced postthreshold cost shares Do you cover excluded drugs as part of your supplemental coverage drugs used to treat erectile dysfunction Enhanced Alternative ONLY Yes No If you select Yes to Do you cover excluded drugs as part of your supplemental coverage e g drugs used to treat erectile dysfunction you must indicate these specific medications in a flat file which must be uploaded through the Formulary Submission Module by Friday June 8 2012 at 12 00pm EST Is there a Maximum Plan Benefit Coverage amount for excluded drugs C Yes C No Indicate Maximum Plan Benefit Coverage amount for excluded drugs Alternative Enhanced Altemative Characteristics E Do you offer additional gap coverage as part of your supplemental benefit C No ms Additional gap coverage offered by enhanced alternative plans through a supplemental benefit represents coverage that is significantly greater than the standard benefit for generic and brand drugs and provides for additional savings on brand drugs that are applied before the coverage gap discount The additional gap coverage
5. CY 2013 Plan Benefit Package PBP Software Training for Capitated Financial Alignment Demonstration Plans Revised May 30 2012 4 4 CAES PBP 2013 Training Agenda Discuss Relationship Between HPMS and PBP Describe Key Software Features to Entering Data into PBP Describe Basic PBP 2013 Data Entry amp Functionality Describe PBP 2013 Data Entry Specific to Financial Alignment Demonstration Plans Describe Key Features for Completing the PBP IC Ry gt fe 2 CATS 3 CONTI AN 4 UC ey reqa HPMS and PBP Software o is central repository of all Organization Plan Bid data CY2013 plans are created in HPMS the Bid Submission Module Released on April 6 2012 e PBP Software Package downloaded from HPMS o HPMS Organization 8 Plan Specific Information populated in the PBP Software m ty g T 3 CATS h CONTE MEETA 4 FINITE ey rara HPMS and PBP Software The HPMS Bid 2013 Start Page lists the following steps to complete the download of the PBP software and plan data Step 1 Download the PBP Software Step 2 Install the PBP Software Step 3 Set up your plan specific information Step 4 Edit your plan marketing information Manage Plans Step 5 Ensure all your organization level data is complete in the Contract Management Module Step 6 Download your plan specific
6. b s i he HPMS Contract Management Reports Service Area Report Contract Service Area Plan Service Area Plan Segment Service Area Contract and Plan Information Report Outlines contract level information e g Org Type Org Geographic Name Corporate Website etc and includes contract level and plan level contacts Plan Crosswalk Report To view after bid submission This report shows the crosswalk of CY2012 to CY2013 plans and what counties were added reduced NOTE Crosswalk exceptions WILL be documented in this report Further guidance is coming regarding crosswalk for financial alignment demonstration plans CATS NTPD MEETA 4 NIT Resources PBP Software Technical Issues Silver 410 786 3330 sara silver cms hhs gov Lucia Patrone 410 786 8621 lucia patrone cms hhs gov PBP HPMS Technical Help Desk Help Desk 800 220 2028 hpms cms hhs gov HPMS User Access Questions hpms access cms hhs gov Medicare Medicaid Coordination Office MMCO Mailbox MMCOcapsmodel cms hhs gov MMCO Website http www cms gov Medicare Medicaid Coordination Medicare and Medicaid Coordination Medicare Medicaid Coordination Office FinancialModelstoSupportStatesEffortsinCareCoordination html f N COAT MPERCAAY 4 MER ENVES Vaya
7. A Yt CATH Fn 4 Urn ha d Basic PBP 2013 Data Entry and Functionality Section C Section C Out of Network OON Benefits PPO plan type ONLY Point of Service POS Option HMOPOS plan type ONLY If the plan is an HMOPOS plan type at least one benefit must be offered at POS Plan type HMO or HMOPOS is defined in the 2013 Bid Submission Module Visitor Travel Program V T U S fe v T 3 CATS h CENTERS fue MPEROUM A L reqa Section C Out of Network e Financial Alignment PPOs must offer the same benefits In Network and Out of Network including any Medicaid covered and plan covered benefits e Cost sharing may be imposed for any OON benefit NOTE B 13H data entry will not be available for selection in the OON Screens or any screens throughout Section C ye 4 E y T 3 COAT fen AY 4 OTE AD Um r rea Type of benefit Financial Alignment Demo Plans MUST mark the benefit as mandatory Select service categories for POS Oneor more services must be selected Coverage Limit Enrollee Out of Pocket Cost Limit Deductible Deductible may be imposed for POS benefits Authorization Referral g 5 File Help lt lt Previous Next gt gt Exit Validate Exit No Validate CLICK FOR DESCRIPTION OF BENEFIT Do you offer a Po
8. Exit Copy Plan 9g Data History Report 2g SB Report W Plan Maintenance 2 User Maintenance PBP Copy Plan Step 1 Select a Contract Number 20001 Sample Local Org SS Step 1 Select Source Plan and Destination Plan s Step2 Section 20008 801 000 Completed Completed 801 000 Completed 20008 801 000 New 70007 001 000 A Completed 20003 801 000 A Completed 20007 002 000 Completed To 20005 801 000 New Sample Local PPO MA PD 20007 005 000 Completed 20008 001 000 Completed 20007 008 000 A Completed 70004 001 000 New Sample Local MA PD 70007 009 000 ACompleted 70007 029 000 New 20007 O16 O00 ACompleted 20007 030 000 New Sample Local PPO MA PD 20007 801 000 A Completed 70007 035 000 New 51 3 SectionB Step 2 Select Copy Type Service Category Section A 04 Emergency Care Urgently Needed Servic M Section Select All 05 Partial Hospitalization 01 Inpatient Hospital Services 02 Skilled Nursing Facility SNF 03 Cardiac and Pulmonary Rehabilitation Services 06 Home Health Services Step 4 SectionC gt Step5 04 Emergency Care Urgently Needed Services 05 Partial Hospitalization SectionC Incomplete 06 Home Health xm 07 Health Care Professional Services Step 7 Upload Section Out Of Network Pont Gf Service 4 Upload Yisi
9. A HPMS Data Updates Changes to HPMS Organization Plan data MUST be made in HPMS HPMS data CANNOT be modified in PBP User MUST Download Updated data after it has been modified in HPMS NOTE Downloading updated HPMS data will NOT overwrite currently entered PBP benefits P b v T 2 CATS COAT Ar 4 AD Um t Section A HPMS Data Updates PBP Update Plan Information PBP Management Screen File Actions Preferences Help Report 2g SB Report Maintenance User Maintenance Copy Plan from Previous Year Import Export Reports Update Plan Information Upload Segment User Open Status Enter Data Plan Maintenance for User Maintenance test A Completed Step 3 SectionB Enter Data 01 Inpatient Hospital Services for Section 02 Skilled Nursing Facility SNF E 03 Cardiac and Pulmonary Rehabilitation Services Step 4 Section Section C New Step 7 Upload t Upload Ready 2 s SERVICK Step5 SectionD Step 6 Medicare Rx Drugs SectionD New SectionHBk N A Uy T 3 i CATS 4 COTW fer 4 FTE Urn Section A HPMS Data Updates PBP Update Plan Information Upon completion of plan information updates in HPMS a Zip file called UPDATPBP20
10. cost sharing maximum for all other tiers depending on type of drugs covered in the tier 2 65 for generics 6 60 for brands Must enter the one month cost sharing amount for any extended day supply Chapter 13 Part D Benefit Manual f Avg Expected Cost Sharing is enabled because you offer coinsurance enter O in this field 2 CATS NTPD MEETA 4 NIT lt lt Previous Ext Ext NoVaidete Pre ICL Tier Type and Cost Share Structure Screen PBP Data Entry System Section RX Contract X0000 Plan 000 Segment 0 File Help lt lt Previous Next gt gt Exit Validate Exit No Validate Bo To Alternative Tier Type and Cost Share Structure Pre ICL Tier Tier 2 Tier 3 Tier 4 Tier5 Tier 6 Tier Drug Type s select all that apply Generic Non Preferred Brand Preferred Generic u r r r Non Preferred Generic u u Brand m r r r r Preferred Brand r r r Tier Includes select only one for each tier Part D Drugs Only Excluded Drugs Only e g erectile dysfunction drugs Both Part D and Excluded Drugs 2 Indicate the type of cost sharing structure select only one for each tier Coinsurance Copayment C C C Greater of Coinsurance and Copayment C C C C Lesser of Coinsur
11. e deleted or renamed users will once again encounter the PBP Paths screen during login pT Spreadsheets and the backup path will need to be reestablished wise BET bested Enter hee pth fe BET before proceeding to the PBP Management screen aes Specify the backup path Enter the file path for PBP reports saved to file NOTE This should NOT be on the directory Folder Import Export File Location You should also set the paths where you will store When afin the net pat PEP needs to know ES your other files and reports ue o m Inport Folder Click OK when finished OK Cancel lip gt v E CATS t lt MEANY 4 VATS ty Vaga Set Preferences Options File Actions Preferences bit 3 Copy Plan 98 Data History Report SE Repo Plan Maintenance User Maintenance Step 1 Selec 20978 TI Plan ID P Accessibility Enable 506 Accessibility Options Dacia diii interit v Red and display the other variables in Blue Data Entry Enable vertical screen data entry Custom font size 0 for none Enter Data kx Socken Do not display PEP Splash Screen Step 7 Upload F Ready SERVICI g 3 CATS EN rasa PBP Data Entry by Plan Type Section A Org amp Plan general info Sta
12. entered in the PBP will be inclusive of the standard benefit 21 reduction in beneficiary cost sharing for generic drugs and 2 5 reduction in cost sharing for brand drugs in 2013 but will be in addition to the coverage gap discount for brand drugs For example if a sponsor enters beneficiary cost sharing of 30 for tier 1 generic drugs in the coverage gap the standard generic gap benefit would be satisfied and included in the 70 reduction in cost sharing provided through the supplemental benefit In contrast if a sponsor enters beneficiary cost sharing of 40 for tier 2 brands in the coverage gap the standard brand gap benefit would be satisfied and included in the 60 reduction in cost sharing provided through this supplemental benefit but would be applied first to the plan negotiated price of the brand drug followed by the coverage gap discount of 50 to the remaining drug cost The 2013 standard gap coverage benefit of 21 for generic drugs and 2 5 for brand drugs and the coverage gap discount for brand drugs applies to all benefit types and must be reflected in each plan s bid but should not be entered into the PBP The gap coverage section of the is intended only for those enhanced alternative plans offering additional gap coverage through a supplemental benefit that is over and above the standard benefit for generic and brand drugs and applied before the coverage gap discount for brand drugs CATS PATI for
13. 13 date time ZIP is created You are required to save the new UPDATPBP2013 date time ZIP file to the directory where you installed the PBP2013 software ah v T 3 CATS h CENTERS MPERCAUA A DENS ty rara CATS NTPD MEETA 4 NIT Financial Alignment Demo Plan All demo plans should complete section A data entry as follows Enrollee Type Part A and Part B Does this Plan have a CMS approved Section A Data Entry Continuation Area No 15 your organization filing a standard bid for Section or D of the No oe s o 3 EN 4 rara Basic PBP 2013 Data Entry and Functionality Section B Section B In Network Plan specific Benefits Information 18 Service Categories e 50 Subcategories Medicare covered benefits Enhanced benefits data entry Supplemental benefits covered by the plan OR covered by Medicaid PBP Section B 13h Additional Benefits only available for Capitated Financial Alignment ss Demo plans 5 2 COAT fe MORO 4 Unna Section B Standard Category Questions amp Data Entry 1 Enhanced Mandatory Supplemental ONLY benefits Supplemental benefits MUST be mandatory they cannot be optional Enter applicable plan covered AND OR Medicaid covered benefits throughout Section B 2 Maximum Plan Benefit Coverag
14. ance and Copayment C ur Sw de t v T 3 a CATS t COAT Ar MECCA 4 AD Um 4 Pre ICL Copay and Coinsurance Screen PBP Data Entry System Section RX Contract X0000 Plan 000 Segment 0 Ele Help Previous Next gt gt Exit Validate Exit No Validate GoTo Alternative Retail Pharmacy Copayment and Coinsurance Pre ICL Retail Pharmacy In Network Component Cost Sharing Copayment Coinsurance Daily 1 Month 2 Month 3 Month Avg expected cost 1 Month 2 Month 3 Month Tier 1 Optional sharing 1 Month In Network GE Preferred Non Preferred Tier 2 In Network EN Preferred Non Preferred mmm Tier 3 In Network NEN 3 rT Preferred E 1 Non Preferred sd EE a Tier 4 In Network zz i u Preferred di pe Non Preferred mE pe Tier 5 In Network Preferred NENNEN Non Preferred pe Tier 6 In Network m Preferred mmm Non Preferred I j BEN LP Daily copay amounts are OPTIONAL for CY2013 UPI oe bU a 4 ox nr Th e CATS COAT fer MORO 4 NIT at 3 4 raso All f
15. ces Surgery CO 74 Co Cn E CO P2 E Select All Generate SB Report r Step 2 Display A Report Summary of ee OUCH Bereits Ear Al Report Status Select Completed Plan s for Upload Validate Bid May validate one or more plans at a time Verify SB May only verify one at a time when verifying the SB Introduction and SB sentences will be displayed Upload May upload one or more plans at a time Upload Plan s PBP 82 PEP Management Screen 7 7 7 com TT 9 File Preferences Help 9 Copy Plan B SB Report 8 Plan Maintenance I User Maintenance Copy Plan from Previous Year Import Export Reports gt Update Plan Infos on Upload 88 Plan Maintenance User Maintenance Step 3 Section B7 _ Service Category 17 Eye Exams Eye Wear 18 Hearing Exawes Hearing Aids 4 Step 4 Section Step 6 Medicare Rx Drugs Section Completed Section D Completed Sechon Hx N A Step 7 Upload x t 4 s SEEN ICR Ready d 2 3 CMIS I fe 4 Review Upload Status HPMS Review the status of your uploads in HPMS HPMS Bid 2013 Home 2 Review Upload Status Please note that green check 27 indicates the step has been completed for this contract plan segment Latest Actuaria
16. e for non Medicare benefits only Complete this data entry if there is a dollar cap on the plan covered benefits 3 Maximum Enrollee Out of Pocket costs Only applicable if plan is offering supplemental plan pma benefits 4 CATS COAT MORRO 4 leer File lt lt Previous CLICK FOR DESCRIPTION OF BENEFIT Does the plan provide Chiropractic Services as a supplemental benefit under Part C C Yes C No Select enhanced benefit Routine Care Select type of benefit for Routine Care Exit No Validate Select Routine Care periodicity C Every three years Every two years C Every year Every six months C Every three months C Other Describe Is there service specific Maximum Plan Benefit Coverage amount Yes No Mandatory Optional Is this benefit unlimited for Routine Care Yes No indicate number CATS COAT META 4 NITY Indicate number of visits for Routine Care Indicate Maximum Plan Benefit Coverage amount Select Maximum Plan Benefit Coverage periodicity C Every three years C Every two years C Every year C Every six months C Every three months C Other Describe C Yes B Screenshot 7b Chiropractic Services Base 1 Is there service specific Maximum Enrollee Qut of Pocket Cost No Indicate Maximum Enrollee Out of Pocket Cost amount S
17. e cost shares e Coinsurance copayment e Min Max range Deductible x SERVIC 2 t r E a 4 4 Basic PBP 2013 Data Entry and Functionality Section D Section D plan level Costs Deductible ONLY if there is a plan level deductible for supplemental plan covered services AND OR Medicaid covered benefits NOT permitted to include any Medicare covered services Maximum Enrollee Out of Pocket Cost ONLY if there is a limit on plan covered services AND OR Medicaid covered benefits NOT permitted to include any Medicare covered services Maximum Benefit Coverage Only applicable to supplemental plan covered services Optional Supplemental Packages NOT permitted to create optional supplemental packages CATS COAT fer 4 NIT Section D Deducti File Help Previous Next gt gt Exit Validate Exit No Validate Is there an In Network Plan Deductible Screenshot Go Deductible In Network Hold down the CTRL key your keyboard while selecting the coverage options with your MOUSE After selecting ALL of your options release the Yes No CTRL key on your keyboard Do you charge the Medicare defined Part B Deductible amount Yes Indicate In Network Plan Deductible Amount Select the benefits that apply to the In Network Deductible In Network Medicare c
18. elect the Maximum Enrollee Out of Pocket Cost periodicity C Every three years C Every two years C Every year C Every six months C Every three months C Other Describe Section B Data Entry Continued 4 Coinsurance Copayment Must be 0 for ALL Medicare A B covered services including emergency room PBP Data entry screens ensure cost sharing is entered for all A B covered services Select the click for description of benefit box to understand the Medicare benefit that is covered Appropriate in network cost sharing should be entered for supplemental plan covered benefits AND OR Medicaid covered benefits 5 Deductible Must be 0 for ALL Medicare A B covered services If there is a deductible for in network plan covered supplemental benefits AND OR Medicaid covered this should be entered in the PBP gt CATS NTPD MEETA 4 NIT Section B Data Entry Screenshot PBP Data Entry System Section 7 Contract X000 File Help lt lt Previous Next gt gt Exit Validate Exit No Validate Go 7 Primary Care Physician Services Base 1 CLICK FOR DESCRIPTION OF BENEFIT Is there an enrollee Coinsurance C Yes If cost sharing for this benefit is not the same as primary care No reflect the cost sharing in the range Indicate Minimum Coinsurance percentage for Medicare covered Benefits Maximum Plan Benefit Coverage is not applicable for this
19. ill be reaching out to plans as applicable Some plans may ultimately display the LIS sentences on MPF based on the actual benefits being offered CATS NTPD MEETA 4 NIT Summary of Benefits Report HS PBP Management Screen File Actions Preferences Help A Exit Copy Plan 2g Data History Report SB Report Plan Maintenance User Maintenance Step 1 Select a Contract Number Z0001 Sample Local PPO Org SS Step 2 Section Plan ID Plan Name Segment User 001 Sample Local PPO MA PD 0 002 Sample Local PPO MA PD 0 003 Sample Local MA PD 0 3 SectionB Service Category 04 Emergency Care Urgently Needed Services 05 Partial Hospitalization 06 Home Health Services Step 4 Section Step 5 SectionD SectionC Incomplete SectionD Incom Step 7 Upload t Upload Ready CAVES COAT fer MORRO 4 Urn PBP Summary of Benefits Step 1 Select One or More Categories Introduction Premium and Other Important Information Doctor and Hospital Choice Inpatient Hospital Care Inpatient Mental Health Care Skilled Nursing Facility SNF Home Health Care Hospice Doctor Office Visits Chiropractic Services 10 Podiatry Services 11 Outpatient Mental Health Care 12 Outpatient Substance Abuse Care 13 Outpatient Servi
20. inancial alignment demo plans should select No ICL Full Gap Coverage All other data entry will be grayed out on this screen d b 2 CMS d CONTI EERO 4 NCD DENIES he Alternative ICL All Financial Alignment Demo Plan should indicate No Cost Sharing Full Subsidy individuals pay 0 above the out of pocket threshold 3 3 CMS 1 d CIWTW MPERCAIAV A SCD 298 lt lt Previous Ex Valet Ent No Vale Key Software Features to Complete the PBP File Backups Copy Plan within year PBP Reports Upload Plan s SU PBP File Backups PBP provides archive folder in PBP Installation Directory Automatically stores backup of every upload and update file e Backup files important for security historical reference and to aid in root cause analysis of errors 2 v T 2 4 CATS 2 CONTEE MEERE A NCD DEVES 4 Yer Copy Plan within year Click on ACTIONS in the menu bar Then select the Copy Plan option from the drop down menu OR e Click on the COPY PLAN button in the tool bar Note Only the applicable similar sections will be copied The copy functionality will not overwrite basic properties of the plan e g if you copy an MA PD to an MA it will only copy the MA data and will NOT convert the plan to an MA PD A 3 C
21. information s CMS 4 790 Bid 2013 Download Plan Specific Information Bid 2013 Home Download Plan Specific Information The following 15 list of the counties and or regions that have not been assigned to a plan Partial countes regions are designated with an asterisk and pending service area expansions are designated by pending 20001 EXAMPLE CONTRACT 1 02016 Aleutians West pending 02020 Anchorage pending 02050 Bethel pending 02060 Bristol Bay pending 20002 EXAMPLE CONTRACT 2 01350 Jackson pending 01360 Jefferson pending The following is a list of plans that are missing critical information e g service area plan type or type of employer only plan To complete this information for these plans please select the Back button and select the Set up Plans link under Manage Plans on the Bid 2013 Start Page 20003 EXAMPLE CONTRACT 3 002 Test Z0004 EXAMPLE CONTRACT 4 002 Test The following is a list of plans which you own that have incomplete contact information To complete the required contact information for these contract numbers please select the Edit Contact Data link under Manage Plans on the Bid 2013 Start Page Z0005 EXAMPLE CONTRACT 5 002 Test SERVICE Z0006 EXAMPLE CONTRACT 6 2 e 002 Test v 3 CATS Yt CWO Ae MORO A am nac ty Vasa Overview of PBP PBP Overview Provides standard
22. int of Service POS option Yes No Select type of benefit for the POS option C Mandatory Optional Select the benefits that apply to the POS Benefit Medicare covered Non Medicare covered Hold down the CTRL key on your keyboard while selecting the coverage options with your MOUSE After selecting ALL of your options release the CTRL key on your keyboard Select all of the Medicare covered Service Categories that describe the POS option Inpatient Hospital Acute 1b Inpatient Hospital Psychiatric 2 Skilled Nursing Facility SNF 3 Cardiac Rehabilitation Services 3 Intensive Cardiac Rehabilitation Services 3 Pulmonary Rehabilitation Services 5 Partial Hospitalization 6 Home Health Services 7a Primary Care Physician Services 7b Chiropractic Services 7 Occupational Therapy Services 7d Physician Specialist Services 7e Mental Health Specialty Services Podiatry Services 7g Other Health Care Professional 7h Psychiatric Services 7i Physical Therapy and Speech Language Pathology Services Outpatient Diagnostic Procedures T ests Lab Services 8b1 Diagnostic Radiological Services 8b2 Therapeutic Radiological Services 8b3 Outpatient X Rays x CATS CENTES 4 EAD MNOS Section C POS Screens PBP Data Entry System Section C Contract X0001 Plan 001 POS General Base 1 Select all of the No
23. l Certification Contract Plan Segment Plan Service Area Verification Plan Crosswalk Formulary Crosswalk so Year Lookback Bid Submission Substantiation 001 006 N A TEST CONTRACT 1 N A N A N A N A N A No X62 008 N A T NTRACT 2 N A N A N A N A N A No 009 N A TEST NTRACT 3 N A N A N A N A N A No 011 N A rt TRACT 4 N A N A N A N A N A No 10005 012 N A NTRACT 5 N A N A N A N A N A ZOE 013 ONTRACT 6 N A N A NA No 20007 016 N A TEST CONTRACT 7 N A N A N A No 017 NTRACT N A N A N A N WA No 801 ONTRACT 9 N A N A N 802 TEST CONTRACT 10 N A WA A No 803 N A TE MTRACT 11 N A N A N A N A No Back Go To Bid 2013 Start Pane p SERVICR _ 3 Yt CONTR fe MPERCAAN 4 nace v HPMS Bid Reports Available under Plan Bids PBP Reports available PBP Benefits Report Section B data PBP Out of Network Point of Service Visitor Travel Benefits Report Section C data Plan level cost shares and Limits Report Section D data PBP Part D Benefits Report Rx data PBP Notes Report Medicare Benefit Description Report Service Category Report ou g MEAL Tay o A b rasa SB Reports o Summary of Benefits Report NOTE This is how your benefits will appear on Medicare gov Bid Status Reports e Submission Status Report Bid Status History report Provides upload unload and sent to Desk Review status
24. n Medicare covered Service Categories that describe the POS option 3 Cardiac Rehabilitation Services 3 Intensive Cardiac Rehabilitation Services 3 Pulmonary Rehabilitation Services 7b Chiropractic Services Podiatry Services 9d Outpatient Blood Services 10b Transportation Services 13a Acupuncture 13b Over the Counter OTC Items 13c Meal Benefit 13d Other 1 13e Other 2 13f Other 3 13g Highly Integrated D SNP 14b Annual Physical Exam 14c Supplemental Education Wellness Programs 15 Medicare Part B Rx Drugs 16a Preventive Dental 16b Comprehensive Dental 17a Eye Exams 17b Eye Wear 18a Hearing Exams 18b Hearing Aids 20 Prescription Drugs Cost Plans Only a7 t Section C Visitor Travel Offered Yes No Type of benefit If financial alignment demo plan covers this benefit MUST be a mandatory supplemental benefit The plan must furnish all plan covered services in its designated V T area s including all Medicare Parts A and B services and all mandatory supplemental benefits at in network cost sharing levels consistent with Medicare access and availability requirements at 42 CFR 422 112 us m ty g T 2 CATS CONTI AN 4 UC ey rara Inpatient Hospital Skilled Nursing Facility Outpatient Services 1 15 groups Group together categories that have the sam
25. ndard Bid Section In Network benefits Refer to PBP e Section C Out of Network benefits Matrix in CY Point of Service benefits 2013 Bid Visitor Travel Program Submission User s Manual Section D Plan level costs Section Rx Medicare Part D benefit umi e v T 2 4 CATS 2 4 CATE MPERCAAY 4 FINNIE a ML PBP Data Entry e Questions or variables may or may not be enabled If a question is not enabled the text will be grayed out and you cannot enter data for that variable Questions that are enabled will be displayed in regular text and will allow you to enter data e You must complete all enabled questions The only exception is if an enabled question contains the word Optional in parentheses If you select any option such as No describe or Other describe then you must explain by adding text to the Notes Optional field lt CATS CATE MPERCAAY 4 NCD FINNIE Gy Service category general descriptions Medicare covered benefit descriptions Variable Help On screen Labels PBP General System Help Basic PBP 2013 Data Entry and Functionality Section A General Plan information Most fields entered in HPMS Downloaded into PBP Read only variables Limited data entry for MA and MA PD plans All plan types must Exit with Validation to go on and complete other sections Section
26. opy Plan Within Year PBP Copy Plan Step 1 Select Source Plan and Destination Plan s 20008 801 000 Completed 20008 801 Completed 801 000 Completed 20008 801 000 New 2000 001 000 Completed 20003 801 000 Completed 20007 002 000 A Completed 801 000 New 70007 005 000 Completed 20008 20007 008 000 Completed 70007 009 000 Completed 70007 016 000 Completed 20007 801 000 Completed 2 000 Completed 20004 001 000 New 20007 029 000 New 20007 030 000 New 20007 035 000 New 214 Step 2 Select Copy Section A Section B Select All 01 Inpatient Hospital Services 2 02 Skilled Nursing Facility SNF 03 Cardiac and Pulmonary Rehabilitation Services 04 Emergency Care Urgently Needed Services 05 Partial Hospitalization 06 Home Health 07 Health Care Professional Services Section C Qut Of Network Service Visitor Travel U S Section D Section Hz M Step 3 Assign Copied Plans to User s 1 Step 4 Click to Copy Assign all target plans to a specific user test Assign each target plan to the source plan user Go Copy Close C Keep the currently assigned user for each target plan SERVICE t Co Progress p te CATS COAT er MPERCAP 4 FINNIE PBP Data History Reports PBP Management Screen O x File Actions Preferences Help
27. overed benefits In Network Non Medicare covered benefits Does the In Network Deductible apply to all In Network Medicare covered plan services Yes No CATS COTW fer 4 FTE Urn Select all of the In Network Medicare covered Service Categories to which the In Network Plan Deductible applies Inpatient Hospital Acute 1b Inpatient Hospital Psychiatric 2 Skilled Nursing Facility SNF 3 Cardiac Rehabilitation Services 3 Intensive Cardiac Rehabilitation Services 3 Pulmonary Rehabilitation Services 5 Partial Hospitalization 6 Home Health Services Does the In Network Deductible apply to all In Network Non Medicare covered plan services Yes No Hold down the CTRL key on your keyboard while selecting the coverage options with your MOUSE After selecting ALL of your options release the CTRL key on your keyboard Select all of the In Network Non Medicare covered Service Categories to which the In Network Deductible applies Inpatient Hospital Acute 1b Inpatient Hospital Psychiatric 2 Skilled Nursing Facility SNF 3 Cardiac Rehabilitation Services 3 Intensive Cardiac Rehabilitation Services 3 Pulmonary Rehabilitation Services 4a Emergency Care 7b Chiropractic Services Podiatry Services 94 Outpatient Blood Services 10b Transportation Services 13a Acupuncture 13b Over the Counter Items
28. rk cost sharing needs to be entered in the min max cost sharing fields for this category only Per the May 18 HPMS Clarification email demo plans have the flexibility to include Medicaid covered benefits in either B 13H or in the plan covered supplemental benefits screens ly b v T 2 4 CATS Kun RATTEN fue MPEROUM A Gy rara Section B 13H Additional Services BP Data Entry System Section B 13 Contr File Help lt lt Previous Next gt gt Exit Validate Exit No Validate Go tt13h Additional Services Base 1 CLICK FOR DESCRIPTION OF BENEFIT Enter name of Other 1 Service Does the plan provide Additional Services Enter name of Other 2 Service Yes No Select Additional Services select all that apply Ebrei fult pee Early and Periodic Screening Diagnostic and Treatment EPSDT Services Tobacco Cessation Counseling for Pregnant Women Freestanding Birth Center Services Respiratory Care Services Family Planning Services Nursing Home Services Home and Community Based Services Personal Care Services Self Directed Personal Assistance Services Private Duty Nursing Services Case Management Long Term Institution for Mental Disease Services for Individuals 65 or Older Services in an Intermediate Care Facility for the Mentally Retarded Case Management Other 1 Other 2 Other 3 af t v 2 CATS
29. set of benefits Facilitates CMS bid review and approval process Generates data for CMS Websites Medicare Plan Finder NOTE The SB generated from the PBP will NOT be the SB used for Financial Alignment Demonstration Plans RN x v T 2 4 CATS 3 4 COAT A FINS Gy Yer Key Software Features to Begin Data Entry File Paths and Other Preferences Multi User Environment o Management Screen Data Entry Screen Types of PBP Help Edit Rules amp Exit Validations Year to Year Plan Copy P 4 j CATS t d CWO Ae MORO A am nac 298 Set File Paths PBP File Paths PBP File Paths 5 m Network Configuration The PB P Paths Screen will appear du ring the In itial PBP can store the data collection and plans databases in a different E location e g network drive Enter the file path where the databases will Choose login at which point users must specify a backup reside Database C Program Files PBP207 34ipha Folder path in order to proceed to the PBP Management Screen Backups PBP will backup the data collection databases PBP2013 MDB and PBPPLANS2013 MDB each time it is exited normally Enter the file path where the databases will be copied and zipped Additionally if the backup path specified becomes NOTE This field may not be left blank rue invalid i
30. t be included in the report aM VIC a7 Uy HEALT of e at EN rana PBP History Report PBP History Report File im Print 83 E a TE ge fia ie Backward N Forward Mee eRe pee eee pet Beet Bie The History Report shows what data was entered the date and time it was entered and who completed the data entry PLAN BENEFIT PACKAGE PBP DATA ENTRY SYSTEM HISTORY REPORT HISTORY REPORT FOR Contract 20001 PLAN 001 SEGMENT 000 SECTION RX Data Entry began BY test ON 2 8 2013 9 09 43 4M SECTION RX Data Entry ended BY test ON 2 8 2013 9 12 34 AM SECTION RX Data Entry began BY test ON 2 8 2013 9 22 02 SECTION RX Data Entry ended BY test ON 2 5 2013 9 23 20 SECTION RX Data Entry began BY test ON 2 8 2013 9 23 44 AM SECTION RX Data Entry ended BY test ON 2 8 2013 9 25 19 AM a SERVICES 3 D s CWO Ae A am nac ty Vaga Summary of Benefits Report o Summary of Benefits SB Financial Alignment demo plans should review the plan sentences as they will display on the Medicare Plan Finder MPF Plan sentences generated from data entered in SB related variables red variables in the PBP software The Prescription Drug sentences will automatically display based on data entry in the PBP software Please stay tuned for more information regarding the prescription drug sentence display on the MPF MMCO w
31. tor Travel U S Section D Ready 226 Step 3 Assign Copied Plans to User s Step 4 Click to 7 f Assign all target plans to a specific user test e x SERVICE 2 e Assign each target plan to the source plan user Go Copy Close C Keep the currently assigned user for each target plan Progress CATS COAT fer MORRO 4 FE leer PBP Data Report File m Print 85 ee 00 he 2 2 Backward Forward x L 050 0501 o5 2 4 ava d 3 rcr rb aca ad B roo acp orc or PLAN BENEFIT PACKAGE DATA ENTRY SYSTEM DATA REPORT Does plan utilize floor pricing No Are there quantity limits on certain prescription drugs Yes Is prior authorization required for certain prescription Yes drui 005 1 Do you for Over the Countei en ins OTCs No 5 under the Utilization Management No Do ACROSS in your formulary requin ce rapy Select all Location supply amount s that apply Out of Network Pharmacy one month supply Enter number of days for Out of Network Pharmacy 5 month supply CATS TEEN AERO 4 MNOS Data Report The Data Report displays the data that has been entered for a Section s or Service Category ies Only the questions that you responded to will display in the data report Disabled questions will no
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