Assessment, Care Planning, and Care Coordination

State Approaches to Developing and Operating Ombudsman Programs for Demonstrations under the Financial Alignment Initiative

Ombudsman programs can offer beneficiary protections as part of Medicaid managed care programs. These programs are particularly important for beneficiaries with complex physical and behavioral health conditions, including many dually eligible individuals. For the demonstrations under the Financial Alignment Initiative, the Centers for Medicare & Medicaid (CMS) and states incorporated ombudsman programs to help to resolve enrollees’ problems and alert Medicare-Medicaid Plans (MMPs), states, and CMS of emerging trends and issues.

Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches

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). 

Integrated Care Updates - April 2019

April 2019 Contents:

  • MACPAC Study on Care Coordination in Integrated Programs Serving Dually Eligible Beneficiaries

  • New CMS Initiative to Reform Primary Care Payment

  • Comment Period Extended for the Programs of All-Inclusive Care for the Elderly (PACE) 2020 Audit Protocol

  • Opportunities to Support Enrollment in the Medicare Savings Programs and Extra Help

  • Upcoming CMS Webinars on Medicaid Managed Long-Term Services and Supports

Reducing Avoidable Hospitalizations Among Nursing Facility Residents: Three Perspectives

June-15

The webinar features perspectives and lessons learned from two Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) - HealthPartners in Minnesota and Bridgeway Health Solutions in Arizona - and from The Curators of the University of Missouri, one of seven organizations participating in the CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents.