DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Center for Drug and Health Plan Choice
7500 Security Boulevard, Mail Stop C4-22-04
Baltimore, Maryland 21244-1850
CENTER FOR DRUG AND HEALTH PLAN CHOICE
DATE: October 10, 2008
TO: Current and Future Medicare Advantage Organizations and Part D Sponsors
FROM: Teresa DeCaro, Acting Director, Medicare Drug and Health Plan Contract
Administration Group
Cynthia Tudor, Ph.D., Director, Medicare Drug Benefit and C & D Data Group
RE: Posting of the 2010 Notice of Intent to Apply to Expand Service Area or Become
a New Part C Medicare Advantage, Part D Prescription Drug Benefit and
Employer/Union-Only Group Waiver Plan (Direct Contract or “800 Series)
Sponsor: Deadline November 18, 2008
For the 2010 contract year, the Medicare Advantage, Part D Prescription Drug Benefit, and
Employer/Union-Only Group Waiver Plan (Direct Contract or “800 Series”) Sponsor
applications will be paperless. Each application will be completed through the CMS Health
Plan Management System (HPMS). As a result of the fully electronic submission process
and restrictions on access to HPMS, every initial applicant as well as those current
contractors seeking to expand their organization’s 2009 service area and current contractors
only adding a Special Needs Plan (SNP) to their existing contract and service area must
complete a Notice of Intent to Apply and/or the CMS User ID connectivity form.
The 2010 Medicare Advantage, Part D Prescription Drug Benefit, and Employer/Union-Only
Group Waiver Plan (Direct Contract or “800 Series) Initial and Service Area Expansion and
Special Needs Plan Applications will be posted on the CMS webpage and in CMS’ Health
Plan Management System (HPMS) January 6, 2008 and will be due no later than 11:59 P.M.
EST on February 26, 2009.
Submitting a Notice of Intent to Apply does not bind that organization to submit an
application for the following year. However, without a pending contract number and/or a
completed CMS User ID connectivity form an organization will not be able to access the
appropriate modules in HPMS to complete any of the required 2010 applications.
An organization must complete separate Notices of Intent to Apply for each new initial
product and/or service area expansion it is seeking to offer for the 2010 contract year. Please
also note the following:
• Existing MA-PD sponsors seeking to only add a special needs plan and not expand
their existing service area will not receive a new contract number; however, such
sponsors should still complete the Notice of Intent to Apply Form.
• To the extent your organization is participating through a demonstration that is
expiring at the end of 2009, you will need to submit a notice of intent to apply that
corresponds to the type of contract your organization is converting to for the 2010
contract year.
• For the 2010 contract year all Employer/Union-Only Group Waiver Plan (Direct
Contract or “800 Series”) service area expansions will follow the same application
timeline as the individual market applications.
In an effort to streamline the Notice of Intent to Apply process, this year the forms will be
completed through an on-line web tool. A hardcopy of the web tool form is attached to this
memo as a reference for applying organizations. The attachment identifies which questions
an organization will need to complete to correctly request a 2010 pending contract number
for an initial application and/or ensure appropriate access to a service area expansion
application for an existing organization. Every entity applying for 2010 will need to complete
the first 3 questions of the web tool. Depending on how an entity answers question #3, the
web tool will automatically direct the applicant to the appropriate questions. Organizations
must use the following link to access and complete the Notice(s) of Intent to Apply:
https://vovici.com/wsb.dll/s/11dc4g3795f.
The 2010 Notices of Intent to Apply should be completed by 5 p.m. EST on
November 18, 2008. Organizations that do not complete the NOI by this date may
experience delays in being assigned a contract number(s), which will lessen the amount of
time they can use HPMS for completing their application(s). CMS will send confirmation
emails to organizations once the 2010 Notices of Intent to Apply are processed, but no later
than November 26, 2008.
All initial applicants and existing Medicare contractors will need CMS User IDs and
passwords to access HPMS. Having submitted the Notice of Intent to Apply, initial
applicants can find the CMS User ID application by clicking on the following link:
http://www.cms.hhs.gov/AccesstoDataApplication/
. Completed CMS User ID forms should
be returned to CMS no later than December 8, 2008 to ensure timely processing. Be sure to
indicate where asked all contract numbers which must be affiliated with the CMS User ID.
Note that you will not be able to submit this form until CMS provides your pending contract
number. Return completed CMS User ID forms to:
CMS
7500 Security Blvd
Mailstop C4-14-21
Baltimore, MD 21244
Attn: Lori Robinson
If you are an existing Medicare contractor/HPMS user and would like to connect a pending
contract number to current CMS User IDs, include the following information in an email to
:
Attachment: Notice of Intent to Apply for 2010
NOTE: CMS will only accept electronic submissions of this form. You must access and
submit the form on-line at
https://vovici.com/wsb.dll/s/11dc4g3795f.
FOR NEW OR EXISTING CONTRACTORS SEEKING TO EXPAND OR OFFER NEW
PART C, NEW PART D, OR NEW EMPLOYER/UNION-ONLY GROUP WAIVER PLAN
(EGWP) (DIRECT CONTRACT OR "800 SERIES") PRODUCTS
To ensure clear and timely communication with CMS, all entities applying to offer new
or expanding Part C, Part D, Employer/Union-Only Group Waiver Plan (Direct Contract
or "800 Series" plan) products, or adding a Special Needs Plan to an existing contract
must notify CMS of their intent to apply to offer such a plan by completing the
attached Notice of Intent to Apply form online and submitting it to CMS by 5:00 p.m.
EST on November 18, 2008. Organizations that submit notices of intent to apply forms
are not obligated to submit an application to CMS.
Note: Responses must be completed for each field prior to moving to the next page.
CMS strongly recommends printing responses prior to moving to the next page as
there is no option to print the entire Notice of Intent to Apply after submitting your
responses.
1)
Applicant Organization’s Legal Entity Information.
Legal Entity Name
Street Address 1
Street Address 2
City
State (
Abbreviation)
ZIP Code (Enter 5 or 9-digit ZIP Code with no dashes)
2)
2010 Application Contact Information.
Salutation
(Dr., Mr., Mrs., Ms., etc.)
Name
Title
Address 1
Address 2
City
State (
Abbreviation)
ZIP Code (Enter 5 or 9-digit ZIP Code with no dashes)
Direct Telephone
Fax Number
Email Address
3)
Select the type of Medicare contract request (check ONLY one, multiple new
contracts must submit separate NOI forms).
• PDP (for those applicants that wish to sell only prescription drug benefits (Part D)
only to the individual market and, if applicable, the employer group market) [Skip
to #10]
• MA-only (for those applicants that will offer MA plans without offering Part D
benefits to the individual market and, if applicable, the employer group market.)
[Skip to #4]
• MA-PD (those applicants that wish to offer a Medicare Advantage (Part C) and
Part D benefits to individual and, if applicable, the employer group market) [Skip
to #5]
• Adding Special Needs Plan to an existing contract - No Service Area
Expansion [Skip to Special Needs Plan Note]
• Employer/Union Direct Contract PFFS MAO or PDP sponsor (Employers and
Unions intending to directly contract with Medicare to offer benefits to their
retirees only) [Skip to #8]
• 800-series Only PDP, non-network MA PFFS, or MSA sponsor (for those
entities that wish to ONLY sell to the employer group market) [Skip to #11]
• Service Area Expansion (SAE of an existing contract) [Skip to #12]
• Adding Part D benefits and/or EGWP for the first time to an existing
contract - No Service Area Expansion [Skip to #17]
4)
Select the product type represented by this Notice of Intent to Apply. [complete
only if answer to #3 is MA-only]
• PFFS (no Part D)
• Medical Savings Account (MSA)
• MSA Demonstration
5)
Select the product type represented by this Notice of Intent to Apply. [complete
only if answer to #3 is MA-PD]
• HMO/HMOPOS
• PFFS (with Part D)
• Regional PPO
• PSO
• Local PPODemo--Continuing Care Retirement Community
6
) Indicate the Type of Employer/Union Direct Contract Plan sponsor you intend to
be. [complete only if #3 is Employer/Union Direct Contract MAO PFFS or PDP
sponsor]
•
Direct Contract Prescription Drug Plan sponsor
• Direct Contract Private Fee-For-Service Medicare Advantage Organization (PFFS
MAO)
7
) Indicate plan types you intend to offer. [complete only if #6 is Direct Contract PFFS
MAO]
•
Medicare Advantage Only
•
Medicare Advantage Prescription Drug Plan
8) Indicate the network structure your organization intends to offer. [complete only if
#4, #5 or #6 is PFFS, Direct PFFS, MSA or MSA Demo]
• Full Medical Network
• Partial Medical Network
• No Medical Network
9) Is this applicant organized as a religious fraternal organization? [complete only if
answer to #3 is MA-only or MA-PD]
• Yes
• No
10) Does your organization intend to submit an employer/union-only group waiver
plan (i.e., 800 series) application in addition to an individual market application?
[complete only if answer to #3 is PDP, MA-PD, or MA-only]
• Yes
• No
11) Indicate what type of product you intend to offer. Note that you will offer
Employer/Union-Only Group Waiver Plans (i.e., 800 series plans) only, no plans will
be offered to individual beneficiaries. [complete only if #3 is 800-series only PDP,
non-network MA-PFFS, or MSA sponsor]
• Non-network Private Fee-For-Service (PFFS) Medicare Advantage Only
• Non-network PFFS Medicare Advantage Prescription Drug Plan
• Prescription Drug Plan
• Regular Medical Savings Account
•
Demonstration Medical Savings Account
12) Provide the existing contract number for the 2010 Service Area Expansion
application. [complete only if answer to #3 is SAE]
13) Indicate the market type your organization intends to apply for under this
contract. [complete only if answer to #3 is SAE]
• Individual Market Only
• Individual Market & Employer/Union-Only Group Waiver
•
Employer/Union-Only Group Waiver plan
14) What type of plan do you currently offer under this contract. [complete only if
answer #3 is SAE ]
• CCP: (HMO/HMOPOS, POS, Regional PPO, Local PPO)
• PFFS
• MSA
• MSA Demo
• PDP
•
Cost Plan
15) Provide the existing contract number. [complete only if answer #3 adding Part D
benefits and/or EGWP for the first time to an existing contract – no service area
expansion].
Existing contract number:
16) Does your organization currently offer Part D benefits under this contract?
[complete only if answer #3 adding Part D benefits and/or EGWP for the first time to
an existing contract – no service area expansion].
•
Yes
•
No
17) Does your organization intend to submit a Part D application for your existing
CMS contracted service area? [complete only if answer #3 is adding Part D and/or
EGWP for first time under an existing contract]
• Yes
• No
•
Not Applicable
18)
Does your organization intend to submit an employer/union-only group waiver
(i.e., 800 series) plan application for your existing CMS contracted service area?
[complete only if answer #3 is Existing Contractor adding Part D and/or EGWP for
first time]
• Yes
• No
• Not Applicable
_________________________
Special Needs Plan Note:
[Applies only when #3 is Adding Special Needs Plan to an existing contract - No
Service Area Expansion]
Special Note to MA-PD sponsors intending to only add special needs plan:
As your organization only intends to add a Special Needs Plan (SNP) to an existing
contract, no additional information is needed for the Notice of Intent to Apply.
Provide the existing contract number:
You will not receive a new contract number for this SNP.
_________________________
CONCLUSION:
[All Responses will end with the following screen]
You have answered all required questions for the Notice of Intent to Apply for 2010.
CMS recommends reviewing your responses (click "previous page") and printing each page
prior to submitting your responses.
NOTE: Once you click "Submit 'Notice of Intent to Apply' Responses
Now" you will not be able to return to this specific Notice of Intent to
Apply for 2010.
Thank you.
(Click “Submit Notice of Intent to Apply” button to submit your responses.)
Submit 'Notice of Intent to Apply' Responses Now
