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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 41

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)
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)
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)
Other Resource | July 2019
States’ Medicaid Fee-for-Service Durable Medical Equipment Payment Policies
To better inform analysis of existing policies and development of future policies that affect Medicaid payments, the Medicaid and CHIP Payment and Access Commission (MACPAC) released a compendium of each state’s fee-forservice DME policies along… (Medicaid and CHIP Payment and Access Commission)
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)
Other Resource | January 2019
Strategies to Support Dually Eligible Individuals’ Access to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
This Centers for Medicare & Medicaid Services (CMS) Informational Bulletin provides an additional strategy for states to support timely access to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for people dually eligible… (Centers for Medicare & Medicaid Services)
Brief | November 2018
Building a Stronger Foundation for Medicare- Medicaid Integration: Opportunities in Modifying State Administrative Processes
This brief describes several administrative changes that state Medicaid programs can make to: (1) support integration efforts; (2) improve beneficiaries’ experience of care; (3) decrease beneficiary out-of-pocket costs; and (4) reduce provider… (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)
Brief | June 2018
Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches
This brief describes how three states – California, Connecticut, and Illinois -- promote dually eligible beneficiaries’ access to durable medical equipment (DME) in a fee-for-service environment through the use of provisional prior authorization… (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)
Tip Sheet | June 2017
Four Steps for Managed Care Plans to Promote Person-Centered Planning in Self-Direction Models
This tip sheet suggests steps that managed care plans can take to ensure that case managers are effectively trained on approaches to promote person-centered planning in self-directed delivery models for home- and community-based services. (Integrated Care Resource Center)
June 2017
A Questionnaire to Assess Potential Representatives in Self-Direction Programs
This questionnaire helps individuals and health plan case managers to select an appropriate person to be informally designated as a representative decision-maker. (Integrated Care Resource Center)
Tip Sheet | June 2017
Tips for States to Advance Person-Centered Planning in Self-Direction Models
This tip sheet offers suggestions for states operating managed long-term services and supports programs or other managed integrated care programs to: (1) understand the person-centered planning process; (2) establish robust contract requirements and… (Integrated Care Resource Center)
June 2017
A Questionnaire to Assess Individuals' Ability to Self-Direct Services
This questionnaire helps case managers to assess the ability of an individual to self-direct services, and if the individual requires assistance from a representative. (Integrated Care Resource Center)
Technical Assistance Tool | June 2017
Roles and Responsibilities in a Self-Direction Program
This tool gives examples of the roles and responsibilities of the individual, representative, case manager, information and assistance function, the financial management services function, and the direct care worker. (Integrated Care Resource Center)