DV Phase 1: Planning for DV Activities| Step | Responsible Party | DV Activities | Timeline* |
|---|
| 1 | Sponsoring Organization (SO) | Select independent DVC based on Standards for Selecting a Data Validation Contractor (Appendix A). | December - March |
| 2 | Data Validation Contractor (DVC), SO | Notify CMS of DVC Selection/Request Access to Health Plan Management System (HPMS) Plan Reporting Data Validation Module (PRDVM).
Enter/Update the DVC organization in HPMS. If applicable, enter/update the pre-assessment consultant in HPMS. | January - April |
| 3 | DVC, SO | Complete the web-based Data Validation training. | February - March |
| 4 | DVC, SO | Review all DV documents. | January - March |
DV Phase 2: Performing DV Activities| Step | Responsible Party | DV Activities | Timeline* |
|---|
| 5 | SO | Complete Organizational Assessment Instrument (OAI), also known as Appendix E, and provide appropriate documentation to selected DVC per the OAI’s documentation request | March - April |
| 6 | DVC, SO | Analyze OAI (Appendix E) Responses | March or later |
| 7 | DVC, SO | Prepare for on-site or virtual visit (site visit agenda, resource needs, and logistics) | Early April |
| 8 | DVC, SO | Conduct on-site or virtual review (convene entrance conference, conduct interviews with SO staff, observe SO’s reporting processes, and get census and/or sample files) | Early April |
| 9 | DVC | Request additional documents following on-site or virtual visit (if applicable) | Mid/Late April |
DV Phase 3: Analyzing Results & Submission of Findings| Step | Responsible Party | DV Activities | Timeline* |
|---|
| 10 | DVC | Determine compliance with Data Validation Standards by recording findings in the EES (Appendix B) | April - June 15 |
| 11 | DVC | Submit EES findings to CMS via HPMS PRDVM
and get DV scores | No later than June 15 |
DV Phase 4: Completing Post-Activities| Step | Responsible Party | DV Activities | Timeline* |
|---|
| 12 | DVC, SO | Compile archive of DV work papers | No later than June 15 |
| 13 | DVC | Provide draft findings to the SO | No later than June 15 |
| 14 | DVC, SO | Review EES findings and make necessary
technical and factual corrections | No later than June 15 |
| 15 | SO | Appeal DV determinations (if applicable) | 5 business days following the DV deadline |
*References to December refer to the calendar year before the DV review; all other references to months refer to the same calendar year as the DV review.
Reporting Sections Eligible for Validation in the 2025 DV Cycle
DVCs evaluate the following Part C reporting sections:| Name of Part C Reporting Section | Reporting Year | Reported by SO to CMS Annually, Bi-Annually, or Quarterly | File Upload Into HPMS Yes/No |
|---|
| Grievances | 2024 | Annually | Yes |
| Organization Determinations/ Reconsiderations | 2024 | Annually | Yes |
| Special Needs Plans (SNPs) Care Management | 2024 | Annually | Yes |
DVCs evaluate the following Part D reporting sections:| Name of Part D Reporting Section | Reporting Year | Reported by SO to CMS Annually, Bi-Annually, or Quarterly | File Upload Into HPMS Yes/No |
|---|
| Medication Therapy Management (MTM) Programs | 2024 | Annually | Yes |
| Grievances | 2024 | Annually | Yes |
| Coverage Determinations, Redeterminations, and Reopenings | 2024 | Annually | Yes |
| Improving Drug Utilization Review (DUR) Controls | 2024 | Annually | Yes |