Attachment C - Summary of Structural Changes – CY2009 BPT
Paperwork Reduction Act Submission
CMS-10142
December 28, 2007 Revisions
These revisions are in response to the CY2008 Lessons Survey from industry, feedback from bid reviewers and internal review of the BPTs and instructions. They do not change the estimated burden to the plan sponsors.
MA BPT
Location: Worksheet 1, Section III
Revised input: Enter only plan experience for the Plan ID
Reason: Consistency with Part D bid form.
Location: Worksheet 1, Column f
Removed input: Enter Utilization Type for base period experience on Worksheet 2 instead of Worksheet 1.
Reason: Improved accuracy of BPT. This field was occasionally left blank when experience data was not entered in Worksheet 1.
Location: Worksheet 2, Column e
New input: Enter Utilization Type for base period experience and manual rates on Worksheet 2 instead of Worksheet 1.
Reason: Improved accuracy of BPT. This field was occasionally left blank when experience data was not entered in Worksheet 1.
Location: Worksheet 3, Column i
New input: Enter the effective copay/coinsurance before the impact of the out-of-pocket (OOP) maximum.
Reason: Improved efficiency in determining which service categories are included in the OOP maximum when reviewing plan corrections.
Location: Worksheet 3, cell K67
Removed input: Impact of OOP maximum.
Reason: This figure can be calculated from new data in column i.
Location: Worksheet 3, Columns j through n
Column renumbered: Columns j through n changed to j through o
Reason: Insertion of new column i.
Location: Worksheet 3, Column headings for h and m
Revised column headings
Reason: Renamed to solicit a more complete description of cost sharing to promote ease of comparison with cost sharing in the PBP in reviewing the bid and plan corrections.
Location: Worksheet 1, line o and Worksheets 2 through 4, line p
Delete row: A separate service category for POS was removed. POS base and projected experience and cost sharing must be entered in the appropriate service category.
Reason: To improve consistency in bid data. POS data was entered in this manner for the majority of plans with POS data.
Location: Lines subsequent to Worksheet 1, line o and Worksheets 2 through 4 , line p
Column renumbered:
Reason: Deletion of POS line.
Location: Worksheet 4, Section III
Section deleted: Comparison of cost sharing for covered services with FFS Medicare
Reason: This test is replaced by a more meaningful comparison of the value of the plan cost sharing for Medicare-covered services (col. k) to the value of FFS cost sharing based on projected allowed costs for the plan (col m) during bid review.
Location: Worksheet 4, Sections IV and V
Sections renumbered: Sections IV and V become Sections III and IV
Reason: Deletion of Section III
Location: Worksheet 6, Section IV
New input: Additional contact information
Reason: Improved efficiency of bid review when certifying actuary is unavailable.
Location: 2-year look-back form, 1. Revenue
Deleted input: Combined member premium for basic and A/B mandatory supplemental benefits, deleted unused line and renumber lines.
Reason: Change in bid review policy that this level of detail is not necessary to sufficiently review data.
Location: MSA Worksheets 1 through 5
Revised headings: Non-medical changed to non-benefit
Reason: Consistency with part D for ease of use
Location: MSA Worksheet 1, Column f
Removed input: Enter Utilization Type for base period experience on Worksheet 2 instead of Worksheet 1.
Reason: Consistency with MA BPT for ease of use
Location: MSA Worksheet 2, Column e
New input: Enter Utilization Type for base period experience and manual rates on Worksheet 2 instead of Worksheet 1.
Reason: Consistency with MA BPT for ease of use
Location: MSA Worksheet 3, Section II
New input: Additional contact information
Reason: Improved efficiency of bid review when certifying actuary is unavailable.
MA Bid Instructions
a. Location: General Overview, p5
New instruction: Brief list of material changes to bid form
Reason: Assist plans sponsors in completing the BPT
b. Location: Introductory paragraphs pages 7, 15, 19 and 35
New instruction: Include the experience for enrollees in hospice status when entering data in Worksheets 1 through 5.
Reason: Clarify handling of hospice enrollees.
Location: Worksheet 1, page 8
Updated input table: Added new plan types
Reason: Provide all necessary data entry choices in the drop down menu in the BPT.
Location: Worksheet 1, Section III, pages 7 and 11
Revised instruction: Enter only plan experience for the Plan ID
Reason: Consistency with Part D bid form
Location: Worksheet 1, Column f, Section III, page 13
Revised instruction: Enter Utilization Type for base period experience on Worksheet 2 instead of Worksheet 1.
Reason: Improved accuracy of BPT. This field was occasionally left blank when experience data was not entered in Worksheet 1.
Location: Worksheet 2, Column e, page 15
Revised instruction: Enter Utilization Type for base period experience and manual rates on Worksheet 2 instead of Worksheet 1.
Reason: Improved accuracy of BPT. This field was occasionally left blank when experience data was not entered in Worksheet 1.
Location: Worksheet 3, Column I, page 23
New instruction: Enter the effective copay/coinsurance before the impact of the out-of-pocket (OOP) maximum.
Reason: Improved efficiency in determining which service categories are included in the OOP maximum when reviewing plan corrections.
Location: Worksheet 3, page 24
Revised instruction: Impact of OOP maximum.
Reason: Explain that this figure can be calculated from the new data in column i.
Location: Worksheet 3, Columns j through n, pages 24 and 25
Revised instruction: Columns j through n changed to j through o
Reason: Insertion of new column i.
Location: Worksheet 1, line o and Worksheets 2 through 4, line p
Pages 12
Revised instruction: A separate service category for POS was removed. POS base and projected experience and cost sharing must be entered in the appropriate service category.
Reason: To improve consistency in bid data. POS data was entered in this manner for the majority of plans with POS data.
Location: Lines subsequent to Worksheet 1, line o and Worksheets 2 through 4 , line p, pages 12 - 30
Revised instruction: line labels renumbered
Reason: Deletion of POS line.
Location: Formerly Section III, page 33
Deleted instruction: Comparison of cost sharing for covered services with FFS Medicare (formerly Section III)
Reason: This section was removed from the BPT
Location: Worksheet 4, Sections IV and V, pages 33 and 34
Revised instruction: Sections IV and V become Sections III and IV
Reason: Deletion of Section III in BPT
Location: Worksheet 6, Section IV, page 48
New instruction: Additional contact information
Reason: Improved efficiency of bid review when certifying actuary is unavailable.
Location: Worksheet 6, Section IV, page 48
New instruction: Additional contact information
Reason: Improved efficiency of bid review when certifying actuary is unavailable.
Location: 2-year look-back form, 1. Revenue, page 52
Revised instruction: Combined member premium for basic and A/B mandatory supplemental benefits and renumber lines.
Reason: Change in bid review policy that this level of detail is not necessary to sufficiently review data.
Location: MSA Worksheet 1, Column f, pages 9 and 10
Revised instruction: Enter Utilization Type for base period experience on Worksheet 2 instead of Worksheet 1.
Reason: Consistency with MA BPT for ease of use
Location: MSA Worksheet 2, Column e, page 12
Revised instruction: Enter Utilization Type for base period experience and manual rates on Worksheet 2 instead of Worksheet 1.
Reason: Consistency with MA BPT for ease of use
Location: MSA Worksheet 3, Section II, page 14
New instruction input: Additional contact information
Reason: Improved efficiency of bid review when certifying actuary is unavailable.
PD BPT
Location: Worksheet 1, G15
New input: Network Pricing
Reason: New instruction on a BPT input, in response to updated bidding guidance.
Location: Worksheet 1, K12: N15
New input: Mapping
Reason: New instruction on a BPT input, in response to new bidding guidance.
c. Location: Worksheet 5, G33
New input: Type of Deductible
Reason: New instruction on a BPT input, in response to updated bidding guidance.
d. Location: Worksheet 5, G34
New instruction: Alternative Coverage ICL
Reason: New instruction on a BPT input, in response to updated bidding guidance.
e. Location: Worksheet 5, K33
New instruction: Type of Gap Coverage
Reason: New instruction on a BPT input, in response to updated bidding guidance.
f. Location: Worksheet 6, F60: K61
New instruction: Network Pricing
Reason: New instruction on a BPT input, in response to updated bidding guidance.
g. Location: Worksheet 7, Section IV
New input: Additional contact information
Reason: Improved efficiency of bid review when certifying actuary is unavailable.
PD Bid Instructions
h. Location: Page 34
New instruction: Line 5 – Network Pricing
Select one of the following two choices from the drop-down box: “pass-thru” or “lock-in.”
Reason: New instruction on a BPT input, in response to new bidding guidance.
i. Location: Page 22
New instruction: Line 6 – Mapping
Enter the contract-plan number and corresponding member months for every plan where the plan’s experience is mapped to the base period experience.
Reason: New instruction on a BPT input, in response to new bidding guidance.
j. Location: Page 41
New instruction: Type of Deductible
Select one of the following three choices from the drop-down box: applies to all drugs; applies to brand drugs only; other.
Reason: New instruction on a BPT input, in response to updated bidding guidance.
k. Location: Page 41
New instruction: Alternative Coverage ICL
Enter the initial coverage limit (ICL) for the proposed Alternative Coverage benefit.
Reason: New instruction on a BPT input, in response to updated bidding guidance.
l. Location: Page 41
New instruction: Type of Gap Coverage
Select one of the following five choices from the drop-down box: no coverage; full coverage; partial - increased ICL; partial - generics only; partial - other.
Reason: New instruction on a BPT input, in response to updated bidding guidance.
m. Location: Page 51
New instruction: Network Pricing
Enter the percentage discount off AWP, and the Dispensing Fee for all generic, brand and specialty drugs dispensed at mail or retail.
Reason: New instruction on a BPT input, in response to updated bidding guidance.
Changes October 5, 2005
There are no structural changes to the CY2009 MA and PD BPTs and Instructions.
In the PD BPT, the following labels were changed:
Under I. General Information - #4 of all worksheets, Contract Year was changed from 2008 to 2009.
On Worksheet 1 Section III. Part D Claims Experience, the Allowed Claims Intervals #2 - #5 were updated from the CY2006 to the CY2007 allowed claims intervals.
In the PD BPT Instructions, all references of CY2008 were updated to CY2009.
In the MA BPT, the following label was changed:
Under I. General Information - #4 of all worksheets, Contract Year was changed from 2008 to 2009.
In the MA BPT Instructions, all references of CY2008 were updated to CY2009.
The revisions were necessary for accuracy. The revisions were not made as the result of a change in statute or regulation and neither increase nor decrease the burden.
Page
| File Type | application/msword |
| File Title | PBP-SB 2006 SOFTWARE ENHANCEMENTS |
| Last Modified By | Liz Hale |
| File Modified | 2007-12-29 |
| File Created | 2007-12-28 |