Quality and Performance Measurement

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.

Perspectives on Ombudsman Programs Serving Dually Eligible Individuals: Services Offered and Value Added


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:

Integrated Care Updates- June 2020

Hospital Inpatient Prospective Payment Systems (IPPS) Proposed Rule for Released Public Comment

New Data Detailing COVID-19 Impacts on Medicare Beneficiaries

New ICRC Fact Sheet on Integrated Appeals and Grievance Processes for D-SNPs with Exclusively Aligned Enrollment

Transitioning Members of D-SNP Look-Alikes into D-SNPs or Other Plans

MACPAC June Report to Congress

MedPAC June 2020 Report to the Congress

June 2020 Enrollment in Medicare-Medicaid Plans

June 2020 Enrollment in PACE Organizations

New Resources on the ICRC Website

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


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. The 2021 Star Ratings are now available on CMS’ website. 

Medicare Advantage D-SNP Contract Oversight and Quality Monitoring


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.