CMS Sources Sought: Medicare Part D Patient Safety Quality Analysis

Notice ID: 210320

CMS currently calculates sixteen patient and medication safety measures. Fourteen measures are included in the Part D Star Ratings and Part D Display Measures. Current technical notes for these fourteen Part D measures (D11-D14; DMD05, DMD12-DMD15, DMD17-DMD21) are found here: https://www.cms.gov/medicare/prescription-drug-

coverage/prescriptiondrugcovgenin/performancedata.html. Twice yearly with the release of the measure custodian’s technical measure manual and value sets, CMS tests the value set National Drug Code (NDC) file for completeness against its own NDC file created from commercial drug dictionaries and FDA file [i.e., Comprehensive NDC SPL Data Elements File (NSDE), First Data Bank (FDB) and Wolters Kluwers MediSpan] and Part D claims.

CMS expects to expand its patient safety measures as additional measures are developed through consensus or endorsed by the industry (e.g., Pharmacy Quality Alliance), or developed by CMS and announced in the annual Advanced Notice Call Letter (available at

https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and- Documents.html) and through notice of proposed rulemaking on the Federal Register. Prior to adopting a new or modified patient safety measure, CMS conducts various analyses to determine the measure’s validity and reliability, and to quantify the impact of the changes…

CMS is looking for qualified businesses to support both the patient safety, OMS, and data analysis efforts. At a minimum, the following knowledge, skills, and experience are required:

1. Knowledge of the Medicare program including Parts A, B, C, with a particular emphasis on how the Part D program isimplemented;
2. Strong understanding of Medicare FFS claims and encounter data including claim types, variables and values, and generating final action records;
3. Prior experience with the design and implementation of complex data analyses using CMS data systems and non-CMS databases;
4. Prior experience working within the CMS data systems including the Drug Data Processing System (DDPS); Integrated Data Repository (IDR); Common Medicare Environment (CME); Enrollment Database (EDB); Long Term Care Minimum Data Set (MDS); Part D Standard Analytical File (SAF); Risk Adjustment Processing System (RAPS) File; Health Plan Management Systems (HPMS) files; Common Working File (CWF); Encounter Data Systems (EDS); Medicare Advantage Prescription Drug System (MARx); National Plan and Provider Enumeration (NPPES), and the Provider Enrollment, Change and Ownership System (PECOS), the National Council for Prescription Drug Programs (NCPDP). Comprehensive NDC SPL Data Elements File (NSDE), First Data Bank (FDB) and Wolters Kluwers MediSpan;
5. Prior experience in the analysis of Part D drug use and potential inappropriate use, in particular opioids, including: the calculation of morphine milligram equivalents (MME) using the CDC conversion factors, identifying opioid naïve beneficiaries, and identifying beneficiaries with an opioid-related overdose diagnosis;
6. Experience in maintaining quarterly NDC files for ‘actively marketed’ drugs within specific drug classes over time using both FDB, MediSpan and NSDE;
7. Ability to make recommendations and identify beneficiaries for exclusion and inclusion from measures or analyses using: diagnoses from multiple CMS data sources (i.e., EBD, claims, RAPS), long-term-care residency (i.e., PDE, MDS), procedure codes, and hospice enrollment;
8. Prior experience integrating multiple–years of very large administrative health claims1 and supplemental data to construct datasets for both internal and project-related use…

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Related Item

CMS MEDICARE PART D PATIENT SAFETY QUALITY ANALYSIS SUPPORT