Medicare Resources

Integrated Care Updates - January 2020

January 2020 Contents:

New ICRC Flow Charts Compare Existing and New Unified Appeals and Grievance Processes for Individuals Enrolled in Applicable Integrated D-SNPs
CMS Releases Additional Guidance on D-SNP Integration Requirements
CMS Releases the 2021 Medicare Advantage Advance Notice
MACPAC Considers Policy Options to Better Integrate Care for Dually Eligible Individuals
January 2020 Enrollment in Medicare-Medicaid Plans
January 2020 Enrollment in PACE Organizations
Key Upcoming Dates

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

Alignment of Medicare Savings Program Eligibility with the Medicare Part D Low Income Subsidy Program

The Medicare Savings Programs (MSPs) are Medicaid programs (or categories of Medicaid eligibility) that provide payment for Medicare premiums and/or cost sharing for low-income individuals. This tip sheet details one way a state can improve the MSP eligibility determination process by aligning its MSP eligibility criteria with those used for the Medicare Part D Low-Income Subsidy (LIS) program to facilitate the use of LIS eligibility data in determining eligibility for MSPs.

Key Medicare Advantage Dates and Action Items for States Contracting with Dual Eligible Special Needs Plans

This calendar of key Medicare Advantage dates describes program milestones by month and explains what activities state Medicaid agencies may want to undertake to prepare for or respond to a particular Medicare Advantage event.