Oversight and Monitoring

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:

04/18/2019

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.

This resource shows how states can use data from the Centers of Medicare and Medicaid to create tables, graphs, and figures and interpret their meaning in order to assess D-SNP performance.

Oversight and Monitoring

Improving Quality and Performance in Dual Eligible Special Need Plans (D-SNPs): Monitoring and Oversight Tips for States

D-SNP Performance Monitoring and Oversight: State Experiences and CMS Resources

How States Can Use Medicare Advantage Star Ratings to Assess D-SNP Quality and Performance

Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Using Medicare Program Audit Reports to Improve Managed Care Organization Oversight

How States Can Monitor Dual Eligible Special Needs Plan Performance: A Guide to Using CMS Data Resources