CMS Medicare Guidance, Rulemaking, and Public Comments

Additional Guidance on CY 2021 Medicare-Medicaid Integration Requirements for Dual Eligible Special Needs Plans (D-SNPs)

This HPMS memo provides additional guidance and clarification on four topics related to new integration standards for Dual Eligible Special Needs Plans: (1) distinctions between fully integrated D-SNPs (FIDE SNPs) and highly integrated (HIDE SNPs); (2) permissibility of carve-outs of behavioral health services and long term services and supports (LTSS) for FIDE SNPs and HIDE SNPs; (3) alignment of D-SNP and companion Medicaid plan service areas; and (4) compliance with integration requirements for D-SNPs that only enroll partial-benefit dually eligible individuals.

CMS Issues Memo to Medicare Advantage Plans to Encourage Continuity of Care for Dually Eligible Enrollees Currently Receiving Opioid Treatment Program Services through Medicaid

On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing a new opioid treatment program (OTP) benefit under Medicare Part B, starting January 1, 2020.

Spotlight: Final CMS Changes to Medicare Physician Payment and Opioid Use Disorder Benefits for Calendar Year 2020 Could Have Implications for State Medicaid Programs

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates policies for services furnished under the Medicare Physician Fee Schedule and for Opioid Use Disorder (OUD) services in calendar year (CY) 2020 and thereafter.

The changes may have implications for states that:

Spotlight: Comments Requested on Proposed “Applicable Integrated Plan Coverage Decision Letter”

CMS requests comments from, states and other stakeholders on proposed new Plan Coverage Decision Letter for use in 2021 by Dual Eligible Special Needs Plans (D-SNPs) with unified Medicare and Medicaid appeals and grievance procedures. Comments are requested by December 17, 2019.

Spotlight: CMS Proposed Changes to Medicare Physician Payment for Calendar Year 2020 Could Have Implications for State Medicaid Programs

CMS Releases Final Rule on D-SNP Integration and Integrated Appeals

On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) published new final rule for Medicare Advantage and Part D that implements provisions of the Bipartisan Budget Act of 2018 related to the integration of Medicare and Medicaid services and unification of Medicare and Medicaid grievance and appeals procedures by Dual Eligible Special Needs Plans (D-SNPs).

CMS' Medicare Advantage and Part D Rates and Guidance for Calendar Year 2020

On April 1, 2019, the Centers for Medicare & Medicaid Services (CMS) published the Final Call Letter and Rate Announcement outlining guidance for the 2020 plan year for Medicare Advantage (MA) plans, including Dual Eligible Special Needs Plans (D-SNPs) and Medicare-Medicaid Plans (MMPs) under the Financial Alignment Initiative.