Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This webinar describes the Medicare resources available to states to monitor D-SNP performance and provide tips for states on incorporating D-SNPs into Medicaid quality improvement activities.
Learning Objectives: By the end of this presentation, attendees should be able to:
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).
In response to the spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) has suspended non-emergency federal and state survey agency surveys. Consistent with that action, CMS is reprioritizing scheduled program audits for Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid Plans, and PACE oganizations. Oversight will continue but will shift to prioritize the investigation and resolution of instances of noncompliance where the health and/or safety of beneficiaries is at risk and complaints allenging infection control concerns.
This webinar covers resources and strategies available to states to begin or improve their oversight of Dual Eligible Special Needs Plans (D-SNPs). Presenters provide an overview of the Centers for Medicare & Medicaid Services’ (CMS) publicly available D-SNP performance monitoring resources and share approaches used by Oregon and Tennessee to incorporate performance monitoring and oversight requirements into D-SNP contracts.
The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to evaluate the performance of Medicare Advantage (MA) health plans. This Star Rating system enables beneficiaries, payers, and others to compare plans across multiple dimensions. CMS publishes the Star Ratings each year – usually in October – to help beneficiaries find the best plan for them and to determine MA quality bonus payments to plans. The lowest-ranking plans receive one star, and the highest ranking plans receive five stars.
This tip sheet describes how states can use the results of Medicare program audits to identify performance issues impacting dually eligible beneficiaries’ receipt of care coordination, long-term services and supports, durable medical equipment, and other services, and incorporate that information into their audit and oversight activities.
In this presentation, an ICRC speaker describes the basic principles of MLTSS program oversight and state performance monitoring practices for Medicaid MLTSS programs. In addition, a speaker from Texas offers operational insight on oversight of the STAR+PLUS program.
This presentation describes the readiness review process that Tennessee used with health plans participating in its Medicaid MLTSS program.
This presentation highlights the ICRC technical assistance tool State Contracting with Medicare Advantage Dual Eligible Special Needs Plans: Issues and Options and features a moderated panel discussion among representatives of three states (Minnesota, New Jersey, and Tennessee) with a wide range of experience in contracting with D-SNPs.
This webinar summarizes a discussion among states, the Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors, and ICRC about Medicare Advantage Dual Eligible Special Needs Plan contract oversight and quality monitoring procedures.