CMS-10137 30-day comment #1

V

FACE
Assoelation

80 1 N.Fairfax Street, Suite 309
Alexandria, VA 22314
Phone: 703/$35-1565 F a x 703/535 1566
Web site: www.npaonlineorg

PHONE:

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OMB Hunmr RCSOI~~CCI
and floeillg Branch
Actcution: Carolyn Lovet1
New F.xecitivc Olhcc Building, Room 10235
Washington, DC 20503
Firx Numb=: (202) 395-6974
rcvitwii~gthc Melcare PaxT D ~pp1ic;cGonfor New PACE Org3nizations fur the 2009
Contncr Year, h e Natio~~al
PACE Associa~onMA)
wuuld likc to commcnt in regard to the
ar*aciation!i required UP PACE orguizatians related to Clnims Processiug. In r1.r~2007 version of
the appliclutloft,applicants attcstad to their abilily w cirlm:

a.) Conuan with a rhlrd pluty b t agrees to develop and nperatc an on-lineclaims yrwssin&
syslcms thr~toperates in real time tn ensure accurate and timely pxymcnt of all claims submiaed
5). networi p h m a c i c s . OR

b) I-hvc hcmal procedu~su i place t o aqsure occurare and rirnely payrntnf of all claims
submineu I)y rlchvsrk pknrmsciw.

in the 2004 Parc'r) applicarion, option (I
is J
r.o longer
) lewd.
\Vr are cor cerncd that amissja of uption (b) results in a r e q u u c n l m r t h ~ PACE
l
argmizadcui w s t pmcass claims In real hnr: r e g ~ d l e c of
s how they organize th: p~nvzsionof
Part L)drug to thelr enroIlaes. Unlike typical Medicare bencficiarie.9, PACE enrollees, all of
vd~brnare 1,rcr;rified cllgible for nursing horlle level of carc. ~enmlly
do nut acqutrc their drugs
ficrm local pharmacies. Pather,PACE or,pizatiuns arrangc far medications UJ be delivered to

e~uoileel:in the PACE cenTer or in rheir homes. Also, undsr PACE r e e l a t m y requiremenu,
P!LCE Orgi n i ~ a t i arc
o ~ prohib~tedf i o n charghg d~ciraxolicc; coa-charing WUO~UIT~ SO rurl
nrle prow~sing1s not required at ~ b pornc
c
of sale. NP.4 is concf.meti that rhls new requircmmls
will irnposr- 8 v a y subfia~tialbuxden on PACE orgamzetious chat is no[ w a i r a n t d in order to
sure b e :?proprare adminisrm(ion of the Pan D brnvfit ar r.hc bencficlary Iwel.

W s are h o ~ c f&at
~ l CMS and other^ as a ~ o p r i z k w i l cngagc
l
NPA and its PACE provider
~licmbe~s
i r ~a d i d o ~ in
e urde~to fr~lly
undersmd h e impact of n req~~ircment
for "an on-line
cklms proc rising sptcrn 'hot operare6 ul I rr=altime" heforc imposing such a substantial new
tcquircment on PACE provider$.

FOTquestions and furtl~erfollow-up. please contact CLISvan Rccnen at the NPA at (70;) 5351558 ni- c

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