Apr 25 -- The Centers for Medicare & Medicaid Services (CMS) invites comments by June 26, 2023 regarding the proposed extension of Medicare Part C and Part D Data Validation.
Sections 1857(e) and 1860D–12 of the Social Security Act (“the Act”) authorize CMS to establish information collection requirements with respect to MAOs and Part D sponsors. Section 1857(e) (1) of the Act requires Medicare Advantage Organizations (MAOs) to provide the Secretary of the Department of Health and Human Services (DHHS) with such information as the Secretary may find necessary and appropriate. Section 1857(e) (1) of the Act applies to Prescription Drug Plans (PDPs) as indicated in section 1860D–12. Pursuant to statutory authority, CMS codified these information collection requirements in regulation at §§ 422.516(g) Validation of Part C Reporting Requirements, and 423.514(j) Validation of Part D Reporting Requirements, respectively.
Organizations contracted to offer Medicare Part C and Part D benefits are required to report data to CMS on a variety of measures. CMS has developed reporting standards and data validation specifications with respect to the Part C and Part D reporting requirements. These standards and specifications provide a review process for MAOs, Cost Plans, and Part D sponsors to use to conduct data validation checks on their reported Part C and Part D data. The data validation is “retrospective,” referring to the fact that it normally occurs in the year subsequent to the measurement year. For example, the data validation for CY 2012 data was conducted in CY 2013. In order to ensure the independence of the data validation, organizations will not use their own staff to conduct the data validation. Instead, MAOs, Cost Plans, and Part D sponsors will be responsible for acquiring external data validation resources.
Data validation provides CMS with assurance that plan-reported data are credible and consistently collected and reported by Part C and D SOs. CMS uses validated data to respond to inquiries from Congress, oversight agencies, and the public about Part C and D SOs. The validated data also allows CMS to effectively monitor and compare the performance of SOs over time. Validated plan-reported data may be used for Star Ratings, Display measures and other performance measures. Additionally, SOs can take advantage of the DV process to effectively assess their own performance and make improvements to their internal operations and reporting processes.
Number of Respondents: 809; Total Annual Responses: 809
CMS posts public use files of plan-reported data on an annual basis, following the data validation process and other CMS reviews. CMS cannot guarantee the release of these data to meet any timeframe. Most of these data have undergone the data validation process and are used by CMS for operational purposes. Users should carefully review the Technical Specifications, including information included in the CMS Disclaimer and User Agreement about data integrity, and privacy protection. Data reporting requirements and technical specifications may change from year to year. Therefore, users must familiarize themselves with any modifications to the reporting requirements or technical specifications when considering these data across plan years.
Medicare Part C/Part D Data Validation
https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/partcddatavalidation
CMS draft data collection instruments and technical documentation:
https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing-items/cms-10305
FRN:
https://www.federalregister.gov/d/2023-08717