Capitated Model

Medicare-Medicaid Plan (MMP) Enrollment Restrictions Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

This technical assistance tool describes the regulation that allows Medicare plans that provide prescription drug coverage (including MMPs) to use drug management programs to limit access to certain controlled substances determined to be “frequently abused drugs” for patients who are determined to be at-risk for prescription drug abuse due to the Comprehensive Addiction and Recovery Act of 2016 (CARA).

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The MyCare Ohio Demonstration: Early Successes and Stakeholder Insights on Integrating Care for Dually Eligible Beneficiaries

To provide more integrated, coordinated care for its residents who are dually eligible for Medicare and Medicaid, Ohio is operating a demonstration under the Financial Alignment Initiative offered by the Centers for Medicare & Medicaid Services. This case study describes: (1) the demonstration’s structure; (2) results achieved to date; and (3) insights on the demonstration’s implementation from the state and other stakeholders.

An Exploration of Consumer Advisory Councils within Medicare-Medicaid Plans Participating in the Financial Alignment Initiative

The Center for Consumer Engagement in Health Innovation released a report The Biggest Value is Getting the Voice of the Member describing its findings on the composition, function, and impact of the Consumer Advisory Councils operating within Medicare-Medicaid Plans (MMPs) operating in capitated model demonstrations under the Financial Alignment Initiative. The report covers topics including, recruitment and training of consumer members, accommodations to help consumers participate, and ensuring representativeness and diversity.

State and MMP User Guides for MMP Enrollment Processing

Medicare-Medicaid Plan (MMP) Technical Guide to Eligibility and Enrollment Transaction Processing

This guide describes the interface that states with Financial Alignment Initiative Demonstrations use to conduct Medicare eligibility verification and MMP enrollment submission to the CMS MARx systems.

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Technical Operation Considerations for Implementing Enrollment Periods for States Participating in the Capitated Model Financial Alignment Initiative

This webinar provides background on the technical operations updates to Medicare enrollment transactions and processing for dually eligible beneficiaries related to the changes from the Medicare Part C/D final rule released on April 2, 2018. The presentation also discusses the technical operation considerations for enrollment of beneficiaries in Medicare-Medicaid Plans (MMPs).