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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 48

Other Resource | June 2024
Lessons Learned from Dual Eligible Special Needs Plans Enrollee Advisory Committee Strategic Conversation
This memorandum outlines lessons learned from a series of strategic conversations the Centers for Medicare & Medicaid Services held with Medicare Advantage organizations in December 2023 and January 2024 regarding calendar year 2023… (Centers for Medicare & Medicaid Services)
Technical Assistance Tool | July 2023
Glossary of Terms Related to Integrated Care for Dually Eligible Individuals
This resource was updated in July 2023 to include updated definitions of Dual Eligible Special Needs Plans (D-SNPs), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs), and… (Integrated Care Resource Center)
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)
Tip Sheet | May 2023
Tips to Help States Select Medicaid Managed Care Authorities as They Design Integrated Care Initiatives for Dually Eligible Individuals
This tip sheet summarizes key considerations for states trying to decide which pathway to use to advance Medicare-Medicaid integration, and which Medicaid managed care authority(ies) might best support that pathway. Although the tip sheet presents… (Integrated Care Resource Center)
February 2023
Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid
This report provides data on the characteristics of dually eligible individuals and information on their use of services and costs of care. (Medicare Payment Advisory Commission)
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)
Tip Sheet, Other Resource | April 2022
Dually Eligible Individuals: The Basics
ICRC has developed a basic fact sheet on individuals who are dually eligible for Medicare and Medicaid. (Integrated Care Resource Center)
Technical Assistance Tool | December 2021
Fillable Tables for States Assessing the Fiscal Viability of a Medicare Part A Buy-in Agreement
States may execute a Medicare Part A buy-in agreement with the Centers for Medicare & Medicaid Services (CMS) to facilitate access to Medicare Part A and dual eligible status under the Qualified Medicare Beneficiary (QMB) eligibility group. This… (Integrated Care Resource Center)
Technical Assistance Tool | December 2021
Assessing the Fiscal Viability of a Medicare Part A Buy-in Agreement in Group Payer States
States may execute a Medicare Part A buy-in agreement with the Centers for Medicare & Medicaid Services (CMS) to facilitate access to Medicare Part A and dual eligible status under the Qualified Medicare Beneficiary (QMB) eligibility group. This… (Integrated Care Resource Center)
Brief | March 2021
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… (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
Data Analysis Brief: Managed Care Enrollment Trends among Dually Eligible and Medicare-only Beneficiaries, 2006 through 2018
This analysis examines trends in enrollment and eligibility for Medicare-Medicaid enrollees. (Centers for Medicare & Medicaid Services)