crosswalkPRA4_23_10

Additional Programming changes to Automatice TrOOP Balance Transfer (ATBT) Process

The additional changes to the ABTB process are being made to (1) calculate and maintain monthly TrOOP and Total Drug Spend benefit accumulator totals for each part D beneficiary, (2) to transmit those monthly values whenever they receive electronic inquiry transactions from the CMS TrOOP Facilitator, (3) to receive electronic update transactions containing accumulator values from previous plans on their new enrollees, and (4) adjust their enrollees’ TrOOP and Total Drug Spend benefit accumulators to reflect utilization in previous Part D plans.  This requirement automates the process of ensuring beneficiaries are placed in the proper benefit stage reflecting their total Part D annual utilization to date despite midyear plan switching.

List of Changes to the Current Collection Instrument

REQUIREMENT: Part D sponsors are required to apply protections against high out-of-pocket expenditures by tracking TrOOP expenditures. Additional requirement to further automate transfer process currently in place.

SOURCE: 1860D-23, 1860D-24, 42 CFR 423.464

DOCUMENT AND PAGE NUMBER: Automated Troop Balance Transfer Process HPMS Memo – 10/20/2008, Modification to the TrOOP Facilitator Contract – Appendix H.

CITATION: 42 CFR 423.464

REASON WHY CHANGE IS NEEDED: This requirement automates the process of ensuring beneficiaries are placed in the proper benefit stage reflecting their total Part D annual utilization to date despite midyear plan switching.

IMPACT ON BURDEN: Increases burden.