Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This memo provides answers to questions related to two CMS memos released on April 21 and April 23 for Medicare Advantage and Part D plans (including D-SNPs and Medicare-Medicaid Plans (MMPs)) describing guidance for plans related to the COVID-19 pandemic. This guidance contains several points of potential interest for states with integrated care initiatives.
February 2020 Update Content:
April 2020 Update Contents:
Centers for Medicare & Medicaid Services (CMS) issued a memo detailing important updates on CMS processes for review and approval of state Medicaid agency contracts (SMACs) for contract year 2021. These updates acknowledge the unique circumstances resulting from Dual Eligible Special Needs Plans’ (D-SNPs’) and states’ priority focus on the COVID-19 public health emergency.
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 will 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).
This memo provides updated information related to previously issued April 21, 2020 guidance, "Information Related to Cronavirus Disease 2019 - COVID-19."
This memo describes the annual capitation rate for each Medicare Advantage payment area for CY 2021 and the risk and other factors to be used in adjusting these rates.
In response to the unique circumstances resulting from D-SNPs’ and states’ priority focus on reducing the risks of COVID-19 transmission and maintaining continuity of operations, this memorandum outlines updated CMS processes for review and approval of state Medicaid agency contracts (SMACs) for contract year 2021. The goal is to provide D-SNPs and states with as much additional time as possible to execute contracts consistent with these new regulatory requirements prior to the January 1, 2021, effective date.
On February 5, 2019, the Centers for Medicare & Medicaid Services (CMS) posted a new notice of proposed rulemaking for Medicare Advantage and Part D (see also the accompanying fact sheet). CMS also released the Advance Notice Part II and fact sheet). This e-alert includes notable provisions of the proposed rule and advanced notice.
January 2020 Contents: