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States seeking to integrate Medicare and Medicaid services for dually eligible beneficiaries need to consider a variety of issues in program design and implementation such as incorporating behavioral health and long-term services and supports, consumers and providers engagement, and linking Medicare and Medicaid data. Use the filter below to view resources related to these and other topics.

Displaying 1 - 15 of 28

Technical Assistance Tool | July 2022
Integrated Appeal and Grievance Processes for Integrated D-SNPs with “Exclusively Aligned Enrollment”
On April 16, 2019, CMS released a final rule that implements provisions of the 2018 Bipartisan Budget Act (BBA) requiring greater D-SNP integration, including integrated plan-level appeal and grievance processes for certain “applicable… (Integrated Care Resource Center)
Technical Assistance Tool | July 2022
Appeals and Grievances: Comparisons of Existing and New Integrated Processes for Individuals Enrolled in Applicable Integrated Plans
Beginning in 2021, Dual Eligible Special Needs Plans (D-SNPs) with exclusively aligned enrollment must begin using integrated appeals and grievance processes. The flowcharts in this resource are designed to help states, health plans, and… (Integrated Care Resource Center)
Webinars and Trainings, Study Hall Call | March 2021
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… (Integrated Care Resource Center)
Other Resource | November 2020
Contract Year (CY) 2021 Notices for Applicable Integrated Plans
Please see the attached memorandum entitled "Contract Year (CY) 2021 Notices for Applicable Integrated Plans: “Coverage Decision Letter”, “Letter about Your Right to Make a Fast Complaint” and “Appeal Decision Letter”" from Sharon Donovan, Director… (Centers for Medicare & Medicaid Services)
Other Resource | July 2020
Proposed Addendum to the Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance
Public comments are requested on an addendum to the Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance. Commentors should use the template provided. (Centers for Medicare & Medicaid Services)
Other Resource | May 2020
Contract Year 2021 Models for Applicable Integrated Plans: 'Letter about Your Right to Make a Fast Complaint' and 'Appeal Decision Letter'
This CMS memorandum describes the final Contract Year 2021 model notices for Dual Eligible Special Needs Plans that are applicable integrated plans, "Letter about Your Right to Make a Fast Complaint" and "Appeal Decision Letter", which are both… (Centers for Medicare & Medicaid Services)
June 2017
Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
This third edition of the scorecard measures state performance in creating a high-quality system of care for older adults and people with physical disabilities, and their family caregivers. The report presents results across five dimensions: (1)… (AARP Public Policy Institute)
Study Hall Call | March 2017
Exploring Community-Based Organizations' (CBOs) Role as a Delivery System Partner to Support Vulnerable Populations
This webinar provides an overview of the Administration for Community Living's initiative to improve the business acumen of community-based organizations (CBOs) and features perspectives from a CBO and a health plan on building contractual… (Integrated Care Resource Center)
March 2016
Medicaid Managed Long-Term Services and Supports: Themes from Site Visits to Five States
During site visits to five states (Arizona, Florida, Illinois, New York, and Wisconsin), researchers identified major themes related to the rapid growth of Medicaid managed long-term services and supports (MLTSS) programs and the diversity of ways… (Mathematica)
February 2015
Rebalancing in Capitated Medicaid Managed Long-Term Services and Supports Programs: Key Issues from a Roundtable Discussion on Measuring Performance
This document summarizes key discussions during a roundtable with a group of federal and state officials and other experts on issues related to how rebalancing progress in capitated Medicaid MLTSS programs is measured. (Kaiser Family Foundation)
February 2015
Measuring Long-Term Services and Supports Rebalancing
This fact sheet provides an overview of quality measures related to the rebalancing of long-term services and supports. (Kaiser Family Foundation)
Brief | January 2015
Integrated Appeals Processes for Medicare-Medicaid Enrollees: Lessons from States
This brief explores opportunities for states to develop an integrated appeals process, whether through a D-SNP or a financial alignment demonstration. (Center for Health Care Strategies)
Brief | December 2014
Community-Based Organizations and MLTSS: An Issue Brief to Assess CBO Readiness
This issue brief details four considerations that community-based organizations (CBOs) need to address when assessing the feasibility of participating in a managed long-term services and supports program: (1) relevant skill set and experience; (2)… (National Association of States United for Aging and Disabilities)
Brief | November 2014
Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers
This issue brief examines key themes in 19 capitated Medicaid MLTSS waivers approved to date by the Centers for Medicare and Medicaid Services (CMS), including section 1115 (a) demonstrations in 12 states and 1915 (b)/(c) waivers in six states. (Kaiser Family Foundation)
Other Resource | July 2014
Identifying Community-Based Resources: Key Considerations for Health Plans
This fact sheet for health plans lists community-based resources and how they may help to address the needs of Medicare-Medicaid enrollees. (Resources for Integrated Care)