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Technical Assistance Tool | August 2020
Medicare-Medicaid Plan (MMP) Enrollment Restrictions Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)
This technical assistance tool describes the regulation that allows Medicare plans that provide prescription drug coverage (including MMPs) to use drug management programs to limit access to certain controlled substances determined to be “… (Integrated Care Resource Center)
Technical Assistance Tool | July 2020
Using Medicare Modernization Act (MMA) Files to Identify Dually Eligible Individuals
States need to be able to identify individuals who are (or will become) dually eligible for several reasons. Since 2005, states have exchanged files -- known as the Medicare Modernization Act (MMA) files -- with the Centers for Medicare… (Integrated Care Resource Center)
Technical Assistance Tool | July 2020
State Guide to Identifying Aligned Enrollees: How to Find Medicare Plan Enrollment for Dually Eligible Individuals in Medicaid Managed Care Plans
States can advance integrated care for dually eligible individuals by promoting aligned enrollment in Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and Medicaid managed care plans owned by the same parent company (“affiliated”… (Integrated Care Resource Center)
Technical Assistance Tool | December 2019
State Options and Considerations for Sharing Medicaid Enrollment and Service Use Information with D-SNPs
New federal rules released in April 2019 require that Dual Eligible Special Needs Plans (D-SNPs) must, at a minimum, coordinate the delivery of Medicare and Medicaid benefits. The final rule includes new regulatory language effective January 1, 2020… (Integrated Care Resource Center)
Technical Assistance Tool | July 2019
Using Default Enrollment to Align Coverage for Dually Eligible Medicare-Medicaid Beneficiaries
This fact sheet, updated in July 2019, summarizes default enrollment requirements and state roles in the default enrollment approval and implementation process. It also provides references to additional resources for more detail and… (Integrated Care Resource Center)
Technical Assistance Tool | January 2019
The Complex Art of Making It Simple: Factors Affecting Enrollment in Integrated Care Demonstrations for Dually Eligible Beneficiaries
Dually eligible beneficiaries began enrolling in integrated Medicare-Medicaid plans (MMPs) under the Financial Alignment Initiative (FAI) in calendar year 2013. Under the FAI, the Centers for Medicare & Medicaid Services (CMS) and 10… (Mathematica)
Technical Assistance Tool | November 2018
How States Can Better Understand their Dually Eligible Beneficiaries: A Guide to Using CMS Data Resources
This technical assistance tool shows states how to use data on Medicare-Medicaid dually eligible beneficiary demographics, service utilization, spending, and other characteristics to create tables, graphs, and figures and interpret their meaning for… (Integrated Care Resource Center)
Technical Assistance Tool | January 2018
How States Can Monitor Dual Eligible Special Needs Plan Performance: A Guide to Using CMS Data Resources
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. (Integrated Care Resource Center)
Technical Assistance Tool | September 2017
Medicare Advantage D-SNP Non-Renewals, Service Area Changes, Terminations, and New Entries: CMS Requirements and State Options
This tool outlines CMS' requirements and state contracting options under a variety of situations affecting D-SNPs. (Integrated Care Resource Center)
Technical Assistance Tool | June 2017
Roles and Responsibilities in a Self-Direction Program
This tool gives examples of the roles and responsibilities of the individual, representative, case manager, information and assistance function, the financial management services function, and the direct care worker. (Integrated Care Resource Center)
Technical Assistance Tool | April 2017
Tips for States Using Enrollment Brokers in the Capitated Financial Alignment Demonstrations: Beneficiary FAQs and Suggested Responses
This technical assistance tool lists questions frequently asked by beneficiaries enrolling in capitated Financial Alignment Initiative demonstrations, and provides potential responses by enrollment brokers' customer service representatives (… (Integrated Care Resource Center)
Technical Assistance Tool | December 2015
Training Enrollment Broker Call Center Staff: Tips for States Implementing Capitated Financial Alignment Demonstrations
This tool describes the key areas of information that demonstration enrollment brokers' customer service representatives should master to improve the quality of decision-support services for beneficiaries who are being passively enrolled in a… (Integrated Care Resource Center)
Technical Assistance Tool | April 2014
Selected Provisions from Integrated Care RFPs and Contracts: Participant Direction
This technical assistance tool covers key issues in the development of requests for proposal (RFPs) and contract provisions related to participant-direction options in Medicaid managed LTSS (MLTSS) or integrated Medicare and Medicaid programs. (Integrated Care Resource Center)
Technical Assistance Tool | October 2013
Application of Existing External Quality Review Protocols to Managed Long Term Services and Supports
This tool is a road map for states to use in interpreting and applying existing External Quality Review protocols when assessing Medicaid MLTSS program compliance. (Centers for Medicare & Medicaid Services)
Technical Assistance Tool | July 2013
Selected Provisions from Integrated Care RFPs and Contracts: Consumer Protection
This technical assistance tool covers key issues in RFPs and contracts related to consumer protection including marketing, member materials and education, continuity of care, and grievance and appeals processes. (Integrated Care Resource Center)