Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
Quality and Performance Measurement
Tips for States on Incorporating D-SNPs into Medicaid Quality Improvement Activities
This tip sheet describes the Medicare resources available to states to monitor Dual Eligible Special Needs Plan (D-SNP) performance, explains how states can leverage those resources for Medicaid managed care quality oversight and improvement, and provides tips for states on incorporating D-SNPs into Medicaid quality improvement activities.
Perspectives on Ombudsman Programs Serving Dually Eligible Individuals: Services Offered and Value Added
03/09/2021
This webinar provides an overview of the role of ombudsman programs in integrated care programs serving dually eligible individuals. Using the ombudsman programs developed for the demonstrations under the Financial Alignment Initiative as an example, the webinar examines ways that states have structured these programs, the types of supports that they can offer, and the value they provide to both consumers and state Medicaid agencies.
Learning Objectives: By the end of this presentation, attendees should be able to:
Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RACV) Audit Activities
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.
D-SNP Performance Monitoring and Oversight: State Experiences and CMS Resources
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.
How States Can Use Medicare Advantage Star Ratings to Assess D-SNP Quality and Performance
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.
Communicating Early Results of Integrated Care Efforts for Dually Eligible Individuals: State Approaches
This brief describes approaches that states have used to communicate early integrated care program results. Strategies discussed include developing program indicator dashboards, disseminating beneficiary experience data, and sharing success stories.
Assessing Care Integration for Dual-Eligible Beneficiaries: A Review of Quality Measures Chosen by States in the Financial Alignment Initiative
This brief reviews the quality measures chosen by eight states taking part in CMS' capitated model financial alignment demonstrations as of December 2013.