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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 - 13 of 13

Tip Sheet | June 2023
Definitions of Different Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) Types in 2023 and 2025
This resource was updated in June 2023 to correct an error in the definition of applicable integrated plan in the previous version. Dual Eligible Special Needs Plans (D-SNPs) must hold contracts with state Medicaid agencies, and states can use… (Integrated Care Resource Center)
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)
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)
Other Resource | March 2019
Three New Opportunities to Test Innovative Models of Integrated Care for Individuals Dually Eligible for Medicaid and Medicare
This State Medicaid Director Letter invites states to partner with CMS to test innovative approaches to better serve individuals who are dually eligible for Medicare and Medicaid. The three new opportunities include: capitated Financial… (Centers for Medicare & Medicaid Services)
Other Resource | December 2018
Ten Opportunities to Better Serve Individuals Dually Eligible for Medicaid and Medicare
This State Medicaid Director Letter highlights ten opportunities for states to better serve individuals dually eligible for Medicare and Medicaid. These opportunities, which do not require demonstration authority or Medicare waivers, fall into… (Centers for Medicare & Medicaid Services)
Brief | December 2016
State Insights on Refining Integrated Care for Dually Eligible Beneficiaries
This brief highlights insights from states that are fine-tuning their integrated care programsandcan help other states design their own integrated care programs to meet beneficiaryneeds. (Center for Health Care Strategies)
Brief | December 2016
Snapshot of Integrated Care Models to Serve Dually Eligible Beneficiaries
This brief provides an overview of four integration models: (1) Dual Eligible Special Needs Plan-based; (2) Financial Alignment Initiative-based; (3) the Program of All-Inclusive Care for the Elderly; and (4) accountable care organizations and… (Center for Health Care Strategies)
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 | April 2014
Using Lessons from Disease Management and Care Management in Building Integrated Care Programs
This brief highlights best practices in disease management/care management programs and considers ways in which states can incorporate them into integrated care models like CMS’ Financial Alignment Initiative for Medicare-Medicaid… (Integrated Care Resource Center)
Brief | December 2010
From the Beneficiary Perspective: Core Elements to Guide Integrated Care for Dual Eligibles
This brief describes nine core program elements that are critical for achieving high-quality, patient-centered, and cost-effective care for dually eligible beneficiaries. (Center for Health Care Strategies)