Financial Alignment Demonstrations

State Approaches to Developing and Operating Ombudsman Programs for Demonstrations under the Financial Alignment Initiative

Ombudsman programs can offer beneficiary protections as part of Medicaid managed care programs. These programs are particularly important for beneficiaries with complex physical and behavioral health conditions, including many dually eligible individuals. For the demonstrations under the Financial Alignment Initiative, the Centers for Medicare & Medicaid (CMS) and states incorporated ombudsman programs to help to resolve enrollees’ problems and alert Medicare-Medicaid Plans (MMPs), states, and CMS of emerging trends and issues.

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

8/26/2020

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).

Scripts for Medicare-Medicaid Plan (MMP) Enrollment Brokers Assisting Individuals with CARA Lock-In Indicators

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.

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).

Related Resources:

Medicare Enrollment Periods and Special Election Periods for Dually Eligible Individuals: Reference Tables

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.

Related Resources:

CMS Historical Part A and B Entitlement Data: Introduction to the E&E360 Portal

September 2019

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

Three New Opportunities to Test Innovative Models of Integrated Care for Individuals Dually Eligible for Medicaid and Medicare

This State Medicaid Director Letter 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.

Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches

This MACPAC report reviews and analyzes care coordination requirements in the managed care organization contracts of nine states participating in demonstrations under the Financial Alignment Initiative, 10 states that contract with Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and eight states that contract with Dual Eligible Special Needs Plans (D-SNPs) that are required to have companion plans that provide Medicaid managed longterm services and supports (MLTSS plans).

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.

Integrated Care Updates - May 2019

May 2019 Contents:

CMS Releases PACE Final Rule
New Evaluation Reports for Demonstrations under the Financial Alignment Initiative
Upcoming Resources for Integrated Care (RIC) Webinars
CMS Releases 2017 Medicaid Managed Care Enrollment Reports
May 2019 Enrollment in Medicare-Medicaid Plans (MMPs)
May 2019 Enrollment in PACE Organizations