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Overview

The Centers for Medicare & Medicaid Services' (CMS) Health Plan Management System (HPMS) is a web-enabled information system that serves a critical role in the ongoing operations of the Medicare Advantage (MA), Part D, and Accountable Care Organization (ACO) programs.

HPMS services the MA and Part D programs in two central ways. First, HPMS functionality facilitates the numerous data collection and reporting activities mandated for these entities by legislation. Second, HPMS provides support for the ongoing operations of the plan enrollment and plan compliance business functions as well as for longer-term strategic planning and program analysis.

Specifically, HPMS supports the following business processes for all private health and drug plans participating in the MA and Part D programs:

  • Contract and plan enumeration and management
  • Application submission and review
  • Formulary submission and review
  • Bid and benefit package submission and review
  • Electronic contracting and certifications
  • Marketing material submission and review
  • Audit and assessment of plan performance
  • Plan payment reconciliation data reporting
  • Fiscal soundness
  • Complaint tracking
  • Surveillance and compliance
  • Plan data reporting and performance metrics
  • Financial, plan bid, and plan data reporting audits
  • Coverage gap discount program
  • Electronic health record reporting
  • Cost reporting and audit
  • Plan connectivity
  • Operational data exchanges
  • Data support for the Medicare & You handbook and Medicare Plan Finder
  • Quality improvement
  • Research and evaluation

HPMS also provides system support to the Medicare Shared Savings Program. ACOs are organizations of health care providers that agree to become accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program and are aligned to the ACO. HPMS currently provides system support to the Shared Savings Program for agreement enumeration and management, application submission, application tracking and review, marketing material submission and review, and participant list management.

Because of its crosscutting nature, HPMS has a broad user base comprised of internal CMS staff, private health and drug plans, pharmaceutical manufacturers, ACOs, States, consultants and third party vendors, external federal agencies, and CMS contractors.