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Medicare-Medicaid Coordination OfficeContract Year 2017 Provider and Pharmacy Directory MonitoringFrequently Asked QuestionsAbout this DocumentThe purpose of this document is to respond to common inquiries about the Medicare-MedicaidPlan (MMP) Provider and Pharmacy Directory (Directory) monitoring process. CMS revised theContract Year (CY) 2016 Directory Frequently Asked Questions document to (1) incorporateCY 2017 guidance and (2) include new questions submitted during and after the Directorywebinar1 on June 21, 2017. Where necessary, we renumbered previous questions andresponses and updated webinar presentation slide references and footnotes. We groupedinformation under the following section headings:General . 2Provider Compliance and Outreach . 6Provider Training, Experience, and Licensing Information . 8Pharmacy Information . 9Non-English Languages .10Public Transportation .11Cultural Competence Training .12Accommodations for Individuals with Physical Disabilities .12We indicate any content that has been added or revised since this document was first issued onSeptember 30, 2016, with “*NEW*” or “*REVISED*” at the beginning of the question.Related CY 2018 guidance documents and their estimated release dates appear below. Medicare Marketing Guidelines: July 2017State-specific Marketing Guidance: July-August 2017Chapter 4, Medicare Managed Care Manual: December 20172Until the release of CY 2018 guidance documents, please continue to refer to the CY 2017versions. In addition to the guidance listed above, this document serves as another resourcefor MMPs as they continue to improve their Directories for use by Medicare-Medicaidbeneficiaries. Please contact the Medicare-Medicaid Coordination Office (MMCO) [email protected] with any additional comments or requests for assistance.1Webinar presentation slides from June 21, 2017 are available for download iative/Downloads/MMPPPDWebinar062117.pdf2Chapter 4 will incorporate updated guidance from the January 17, 2017, HPMS memorandum “ProviderDirectory Policy Updates.”1
Medicare-Medicaid Coordination OfficeContract Year 2017 Provider and Pharmacy Directory MonitoringFrequently Asked QuestionsGeneral1. Why does the same element appear multiple times in the table of findings within theMonitoring Results Letter?Each instance of the same element pertains to a different section of the Directory. Multiplesections of the Directory are subject to review. To avoid confusion, we labeled monitoredsections and elements more clearly in the CY 2017 Directory reviews.2. The online Directory’s search results return a count of providers based on the searchcriteria. Does this meet the requirement?MMPs must show the total number of each type of provider in the Directory. Beneficiariesshould not need to enter specific geographic information beyond the state name when usingthe online Directory. MMPs also have discretion to reflect the total number of providersyielded in search results.3. What is the difference between elements that are “Optional” and “Required (asapplicable)”?MMCO defines requirements as follows: Required: Elements must be included as specified in the Directory model to beconsidered compliant. For example, “Indicate if the provider is accepting new patients asof the Directory’s date of publication” or “Include days and hours of operation.” Required (as applicable): Where the requirement is applicable, the element must beincluded as specified in the Directory model. For example, “As applicable, indicate if theprovider has completed cultural competence training” or “As applicable, indicate if theprovider has access to language line interpreters.” It is reasonable to expect thepresence of the element for at least some of the MMP’s network providers. Therefore,the absence of any information or of a disclaimer statement about the element isconsidered not compliant. Optional: The MMP has a choice to include the element or not. The absence of anoptional element has no impact on monitoring and compliance results. For example,“Optional: Include web and e-mail addresses” or “Optional: Indicate if the providersupports electronic prescribing.”4. *NEW*: What does “Partially compliant” mean? Are MMPs penalized when an elementis noted as “Partially compliant”?“Partially compliant” indicates that the MMP included some, but not all, of the componentsnecessary to fulfill the specific requirement. In the CY 2016 monitoring, we scored elementsas either “Compliant” or “Not compliant.” Recognizing MMP improvement efforts in CY 20172
Medicare-Medicaid Coordination OfficeContract Year 2017 Provider and Pharmacy Directory MonitoringFrequently Asked QuestionsDirectories, we included “Partially compliant” where appropriate when scoring multi-partrequirements.5. *REVISED*: What are the possible circumstances for an element to be marked “Notcompliant”?Generally, “Required” and “Required (as applicable)” elements are scored “Not compliant” ifthe element is completely absent from the Directory, missing from more than 50 percent ofthe observations within sections where it is applicable, or missing more than 50 percent ofthe required components if it is a multi-part requirement.6. *REVISED*: What constitutes a print versus an online Directory? Do both the printand the online Directories have to meet the requirements of the Directory model? Areboth versions required on an MMP’s website?For monitoring purposes, PDF versions of the Directory are considered the hardcopy or printDirectory, and search engines on MMP websites are considered the online Directory. Wehold both versions to the same standard and, where both are made available, apply modelDirectory requirements to PDFs and search engines alike. Per the Medicare Managed CareManual, Chapter 4, Section 110.2.1, all versions of the Directory “must contain allinformation and follow all instructions within the CMS model provider directory.”3 As such, tobe considered compliant, all publicly available versions of the Directory must containinformation required in the Directory models. While some MMPs may choose to produceboth online and print Directories for their members, CMS only requires that MMPs publisheither one or the other on their websites.7. *NEW*: Does the required disclaimer to provide “information for free in other formats,such as large print, braille, or audio” apply to the online Directory? Or is it inreference to the print Directory only?All required disclaimers must be present in all published Directories. MMPs typically satisfythis requirement in the online format by posting on the Directory webpage either a simplelisting of disclaimers or a supplemental PDF with disclaimers and any introductory language.An example of the latter is found on slide 14 of the CY 2017 Directory webinar presentation(see footnote 1).3Requirements of the Medicare Managed Care Model, Chapter 4, Section 110.2.1 are incorporated byreference in MMP state-specific Marketing Guidance documents, which are located on/Medicare-and-M
Plan (MMP) Provider and Pharmacy Directory (Directory) monitoring process. CMS revised the Contract Year (CY) 2016 Directory Frequently Asked Questions document to (1) incorporate CY 2017 guidance and (2) include new questions submitted during and after the Directory webinar1 on June 21, 2017. Where necessary, we renumbered previous questions and
