Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
On August 26, 2020 from 1:00-2:30 pm ET the Integrated Care Resource Center (ICRC) hosted a Study Hall Call on Medicare-Medicaid Plan (MMP) Enrollment Processing Updates Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA).
The Comprehensive Addiction and Recovery Act of 2016 (CARA) included provisions that give Medicare Prescription Drug Plans and Medicare Advantage plans (including Medicare-Medicaid Plans (MMPs)) tools to address opioid overutilization.
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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This technical assistance tool provides tables describing both general and special election periods relevant to the enrollment of dually eligible indiviuals in drug management programs into Medicare Advantage plans, including Medicare--Medicaid Plans operating in demonstrations under the Financial Alignment Initiative.
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This webinar and accompanying presenation slides provide information on the historical Part A and Part B data across all eligibility responses, as well as an overview of the E&E360 Eligibility and Enrollment Online Portal.
Agenda:
Historical Part A and B Entitlement Data
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.
On April 24, 2019, CMS released a State Medicaid Director Letter that invites states to partner with CMS to test innovative approaches to better serve individuals who are dually eligible for Medicare and Medicaid. The three new opportunities include: capitated Financial Alignment models; (2) managed fee-for-service Financial Alignment models; and (3) state-specific models.
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.
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.
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).