Announcements

CMS Informational Bulletin and Tip Sheet for OTP Providers on Part B Medicare Opioid Treatment Program (OTP) Benefit for Dually Eligible Individuals

On Tuesday, December 17, 2019, the Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin to provide guidance to state Medicaid agencies regarding coverage changes for dually eligible beneficiaries receiving opioid treatment services. Starting on Wednesday, January 1, 2020, Medicare will begin paying for opioid treatment programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services, including medication-assisted treatment (MAT) medications, toxicology testing, and counseling. In order to be paid by Medicare, OTP providers will need to be enrolled as a Medicare provider. In an effort to prevent any disruption in OTP treatment for dually eligible beneficiaries, CMS is providing background information on provider enrollment and clarifying options for states on coordination of benefits/third party liability under Medicaid as outlined at https://www.medicaid.gov/federal-policy-guidance/downloads/cib121719.pdf.

Additionally, on Thursday, December 12, 2019, CMS released a tip sheet for Opioid Treatment Program (OTP) Providers Serving Dually Eligible Individuals: State Coverage of the Medicare Part B Deductible, which can be viewed at https://www.cms.gov/files/document/otp-crossover-tip-sheet.

State Payment of Medicare Premiums Manual Update

On Friday, December 13, 2019, the Centers for Medicare & Medicaid Services (CMS) released a draft Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”) to states and other stakeholders for review and comment. The manual update is part of CMS’ Better Care for Dual Eligible Individuals Strategic Initiative aimed at improving quality, reducing costs, and improving customer experiences. The draft manual and instructions for commenting are available at: https://www.cms.gov/medicare-medicaid-coordination/medicare-medicaid-coordination-office/state-payment-medicare-premiums.

We are welcoming comments through 5:00 p.m. EST on Saturday, February 29, 2020.

2017 Medicare Historic Parts A and B and Assessments Data Available

Calendar Year 2017 Medicare Historic Parts A and B and Assessments data from the Chronic Conditions Warehouse (CCW) have been final-actioned and are now available for request.

Resources on Opioid Use Disorder Among Dual Eligible Beneficiaries

Beneficiaries dually eligible for Medicare and Medicaid Services may be particularly vulnerable to opioid addiction or misuse. In an October 2016 memo, the Centers for Medicare & Medicaid (CMS) estimated that these beneficiaries have significantly higher rates of co-occurring substance use disorders and chronic pain relative to Medicare-only beneficiaries or Medicaid-only adults with disabilities. Following are two new resources on opioid use disorder among dually eligible individuals:

Data Brief on National Trends in High-Dose Chronic Opioid Utilization Among Dually Eligible and Medicare-Only Beneficiaries (2006-2015)

This data brief provides a baseline understanding of high-dose chronic (HDC) prescription opioid use among dually eligible beneficiaries over the 10-year period from 2006 to 2015. The brief underscores that dually eligible individuals receive prescription opioids at higher rates than those with Medicare-only and that these differences are driven mainly by disability. For example, in 2015, while 10.4% of dually eligible and 4.9% of Medicare-only opioid-using beneficiaries were prescribed opioids at the high dose chronic level. Among those qualifying for Medicare by disability, these rates were 13.4% and 14.7%, respectively. This data brief is available on our MMCO analytics webpage at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Analytics.html.

New Opioid Use Indicators in the Chronic Conditions Warehouse

CMS has created four new Chronic Conditions Data Warehouse (CCW) indicators to promote research on opioid use disorder (OUD).

1. 1. An overarching indicator of OUD.
   2. Diagnosis and procedure-code bases for OUD.
   3. Opioid-related hospitalizations or emergency department visits.
   4. Use of medication-assisted treatment (MAT).

The new indicators use algorithms by developed by experts and vetted during a public comment period. As with all other CCW indicators, the OUD-related indicators facilitate research as well as promote measurement quality and consistency. More information can be found at https://www.ccwdata.org/web/guest/condition-categories.

MMDI’s “Profiling the Provider Role in Opioid Prescribing Among Dual Eligible Beneficiaries – Full Use Case” is Now Available

Research shows that excessive and inappropriate prescription of opioids is a widespread problem among providers and is largely responsible for the observed trends in opioid misuse. This use case will provide guidance to assist SMAs on how to leverage Medicare data to profile providers who prescribe opioids to dual eligible beneficiaries. This will enhance SMAs’ ability to identify opportunities for implementing efforts resulting in safer prescribing analgesic opioids.

• Profiling the Provider Role in Opioid Prescribing Among Dual Eligible Beneficiaries

MMDI’s “Profiling Potential Opioid Misuse Among Dual Eligible Beneficiaries – Full Use Case” is Now Available

Prescription opioid misuse has emerged as a growing epidemic. To address prescription opioid misuse among dual eligible beneficiaries, SMAs must understand prescription filling patterns and factors associated with opioid misuse within this population. This use case shows SMAs how to use Part D Prescription Drug Event (PDE) data, with other Medicare and Medicaid data sources, to examine opioid prescription fills among dual eligible beneficiaries.

• Profiling Substance Use Disorder and Potential Opioid Misuse Among Dual Eligible Beneficiaries 

SDRC Tip Sheet – Public Use Files

A new SDRC Tip Sheet has been added under the Data Dictionaries and File Layouts section. This tip sheet lists free, publicly available data resources from CMS (i.e., Public Use Files or “PUFs”) for state Medicaid agencies to better understand Medicare enrollee experiences in their state and nationally.

CMS-MMCO Announcing Changes to SDRC Support

The Medicare-Medicaid Coordination Office (MMCO) is pleased to announce the State Data Resource Center (SDRC) contract has been awarded to Econometrica, Inc. Econometrica, along with their subcontractor Acumen, LLC, will continue to offer the same level of excellent support to state Medicaid agencies for care coordination and program integrity initiatives that has been provided since 2012. Both contractors will work together to ensure that this transition is as smooth as possible for state Medicaid agencies and their downstream users.

As of today, you can reach the new SDRC Team by:
Email: SDRC@EconometricaInc.com
Phone: (877) 657-9889

New Historic Parts A and B Data Dictionary Available

The historic Part A and B data distributor, GDIT, announced the RIF claims layout was updated to Version K last weekend. The new layout can be downloaded from the Chronic Conditions Data Warehouse (CCW) website. Under Medicare Claims, select Medicare Fee-For-Service Claims – Version K.

Cybersecurity Initiative – CMS Beneficiary Data Protection

The mission of the CMS Cybersecurity Initiative includes the protection of the personal information of the millions of people CMS serves. This includes the protection of the data CMS shares with state Medicaid agencies for the purpose of coordinating care for Medicare-Medicaid Enrollees as well as Program Integrity efforts. As part of this effort, which will strengthen the safeguards in place to protect Medicare data received from CMS, the Medicare-Medicaid Coordination Office (MMCO) requests that state Medicaid agencies review and possibly take action on the following requirements:

1. All data management plans are up-to-date and include up to date protocols for securing data received from CMS.
2. All downstream users and data custodians have signed the appropriate Data Use Agreement (DUA) attachment forms (DUA addenda and Attachment A), Conflict of Interest Letters (Part D data only), or have an up to date COBA Agreement listing all users of the data. Remember, the data cannot be released prior to the appropriate documents being on file and being signed at the State level.
3. All approved planned data uses are current and all Medicare data requested addresses those planned uses.
4. Data that is no longer useful or that are no longer scheduled for planned data uses should be disposed of and a Certificate of Disposition (COD) filed with the CMS Privacy Office.
5. Please review the steps for reporting loss of data and consequences of breaches that are described in the Information Exchange Agreement (IEA) (please see Section IV (loss) and Section IX, part E (breach) of the IEA).