Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This memorandum outlines lessons learned from a series of strategic conversations the Centers for Medicare & Medicaid Services held with Medicare Advantage organizations in December 2023 and January 2024 regarding calendar year 2023 implementation of Dual Eligible Special Needs Plan enrollee advisory committees.
This memorandum provides states with guidance on the process for working with the Centers for Medicare & Medicaid Services (CMS) to establish Dual Eligible Special Needs Plans (D-SNP)-only contracts and develop integrated materials.
On September 8, CMS released the updated Manual for State Payment of Medicare Premiums (formerly called “State Buyin Manual”). The manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid.
On March 9, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule (CMS-9115-F), which is designed to improve patient access to their health information, improve interoperability and encourage innovation, while reducing burden on payers and providers. Two provisions specifically affect dually eligible individuals (see Section VII, Improving the Medicare-Medicaid Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges, and final changes to regulatory text in Parts 406, 407, and 423).
Hospital Inpatient Prospective Payment Systems (IPPS) Proposed Rule for Released Public Comment
New Data Detailing COVID-19 Impacts on Medicare Beneficiaries
New ICRC Fact Sheet on Integrated Appeals and Grievance Processes for D-SNPs with Exclusively Aligned Enrollment
Transitioning Members of D-SNP Look-Alikes into D-SNPs or Other Plans
MACPAC June Report to Congress
MedPAC June 2020 Report to the Congress
June 2020 Enrollment in Medicare-Medicaid Plans
June 2020 Enrollment in PACE Organizations
New Resources on the ICRC Website
On March 9, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule (CMS-9115-F), which is designed to improve patient access to their health information, improve interoperability and encourage innovation, while reducing burden on payers and providers. Two provisions specifically affect dually eligible individuals (see Section VII, Improving the Medicare-Medicaid Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges, and final changes to regulatory text in Parts 406, 407, and 423).
Contract Year 2021 Models for Applicable Integrated Plans: 'Letter about Your Right to Make a Fast Complaint' and 'Appeal Decision Letter’
Contract Year 2021 Medicare Advantage and Part D First Final Rule
Opportunities to Support Enrollment in the Medicare Savings Programs and Extra Help
May 2020 Enrollment in Medicare-Medicaid Plans
May 2020 Enrollment in PACE Organizations
New Resources on the ICRC Website
Key Upcoming Dates
On May 22, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1) that finalizes a subset of the proposals from the February 18, 2020 proposed rule (85 FR 9002). This first final rule implements certain changes before the CY 2021 bid deadline (due by statute on the first Monday in June) stemming from the Bipartisan Budget Act of 2018 (BBA of 2018) and the 21st Century Cures Act.
E-alert regarding the following CMS guidance and resources related to the COVID-19 Pandemic:
- Medicare Part A and Part B Enrollment Equitable Relief for the COVID-19 Pandemic
- Updated Guidance for Medicare Advantage and Part D Plans
- New CMS Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes
On March 9, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule (CMS-9115-F), which is designed to improve patient access to their health information, improve interoperability and encourage innovation, while reducing burden on payers and providers.