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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 - 10 of 10

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)
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)
Other Resource | February 2019
Default Enrollment FAQs
This resource is an FAQ document detailing a number of commonly asked questions regarding default enrollment. (Medicare-Medicaid Coordination Office)
Other Resource | October 2018
Default Enrollment Model Notice
This resource is a model letter that D-SNPs have the option to use to meet CMS beneficiary notice requirements for default enrollment. All letters used will need to contain the required CMS disclaimers, materials ID and receive appropriate CMS… (Medicare-Medicaid Coordination Office)
Study Hall Call | July 2018
Aligning Coverage for Dually Eligible Beneficiaries Using Default and Passive Enrollment
This webinar provides a history of seamless conversion and describes the new process for default enrollment that will start in 2019. This webinar also explains states’ roles in this process, including the need to identify beneficiaries newly… (Integrated Care Resource Center)
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)