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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 39

Tip Sheet | October 2024
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… (Integrated Care Resource Center)
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)
Webinars and Trainings | November 2023
Improving Quality and Performance in Dual Eligible Special Need Plans (D-SNPs): Monitoring and Oversight Tips for States
This webinar describes the Medicare resources available to states to monitor D-SNP performance and provide tips for states on incorporating D-SNPs into Medicaid quality improvement activities. Learning Objectives: By the end of 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 | March 2020
Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RACV) Audit Activities
In response to the spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) has suspended non-emergency federal and state survey agency surveys. Consistent with that action, CMS is reprioritizing scheduled program audits for… (Centers for Medicare & Medicaid Services)
Study Hall Call | April 2019
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)… (Integrated Care Resource Center)
Brief | January 2019
An Exploration of Consumer Advisory Councils within Medicare-Medicaid Plans Participating in the Financial Alignment Initiative
The Center for Consumer Engagement in Health Innovation released a report The Biggest Value is Getting the Voice of the Member describing its findings on the composition, function, and impact of the Consumer Advisory Councils operating within… (Center for Consumer Engagement in Health Innovation)
Study Hall Call | July 2018
Building Relationships between Managed Care Organizations and Beneficiary Ombudsman Programs
This webinar highlights the importance of beneficiary ombudsman programs and provides an overview of available supports, including Medicare resources and state programs that provide assistance to dually eligible beneficiaries. Representatives from… (Integrated Care Resource Center)
Tip Sheet | June 2018
Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Using Medicare Program Audit Reports to Improve Managed Care Organization Oversight
This tip sheet describes how states can use the results of Medicare program audits to identify performance issues impacting dually eligible beneficiaries’ receipt of care coordination, long-term services and supports, durable medical equipment… (Integrated Care Resource Center)
Study Hall Call | March 2018
Partnering with SHIPs to Improve Care
This webinar provides an overview of partnerships between Medicaid agencies and SHIPs in both PA and SC. (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)
Brief | July 2017
Medicaid Agency Partnerships with State Health Insurance Programs: Opportunities to Improve Care for Medicare-Medicaid Enrollees
This brief describes opportunities for Medicaid agencies to partner with State Health Insurance Assistance Programs (SHIPs) in educating Medicare-Medicaid enrollees and their families on new integrated care program options. (Integrated Care Resource Center)
August 2016
Managed Long-Term Services and Supports Rate Setting Resource Center
This resource center gives states tools for developing or refining rate-setting methods for Medicaid managed long-term services and supports (MLTSS) or Medicare-Medicaid integrated care programs. (Center for Health Care Strategies)
Study Hall Call | March 2016
Overview of State Considerations for Medicaid Managed Long-Term Services and Supports (MLTSS) Rate Setting
This webinar features an overview of MLTSS rate setting basics, shares initial findings from a project on Medicaid MLTSS rate setting, and also includes a facilitated discussion with an expert actuary and state representatives from Tennessee and… (Integrated Care Resource Center)