Assessment, Care Planning, and Care Coordination

This MACPAC report reviews and analyzes care coordination requirements in the managed care organization contracts of nine states participating in demonstrations under the Financial Alignment Initiative, 10 states that contract with Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and eight states that contract with Dual Eligible Special Needs Plans (D-SNPs) that are required to have companion plans that provide Medicaid managed longterm services and supports (MLTSS plans). 

Dual Eligible Special Needs Plans (D-SNPs) must develop a model of care (MOC) that describes their enrollees’ characteristics and health and service needs as well as the plan’s care coordination and health risk assessment processes. Despite the importance of Medicaid services to dually eligible enrollees, D-SNPs are only required to describe Medicare services in their MOCs. However, states may require D-SNPs to develop an integrated MOC that describes not just how Medicare services will be provided, but also how the plan will provide and/or coordinate Medicaid benefits.

This technical assistance tool covers key issues in RFPs and contracts related to care coordination including the structure of the care team, development of care plans, caseload requirements, and use of a centralized enrollee record.

This brief outlines the options available to states in both capitated and fee-for-service arrangements to reduce avoidable hospitalizations from nursing facilities.

This brief identifies opportunities for states and their contracting plans that serve Medicare-Medicaid enrollees to better align Medicare and Medicaid coverage of care management using Medicare's new chronic care management payment.

This webinar for California's Medi-Cal health plans highlights strategies for hiring and training care managers in integrated care programs.