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Other Resource | March 2019
Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches
This MACPAC report reviews and analyzes care coordination requirements in the managed care organization contracts of nine states participating in demonstrations under the Financial Alignment Initiative, 10 states that contract with Fully Integrated… (Medicaid and CHIP Payment and Access Commission)
Case Study | February 2019
Using Health Homes to Integrate Care for Dually Eligible Individuals: Washington State’s Experiences
To provide more integrated, coordinated care for its residents who are dually eligible for Medicare and Medicaid, Washington State is operating a demonstration under the Financial Alignment Initiative offered by the Centers for Medicare &… (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)
Technical Assistance Tool | January 2019
The Complex Art of Making It Simple: Factors Affecting Enrollment in Integrated Care Demonstrations for Dually Eligible Beneficiaries
Dually eligible beneficiaries began enrolling in integrated Medicare-Medicaid plans (MMPs) under the Financial Alignment Initiative (FAI) in calendar year 2013. Under the FAI, the Centers for Medicare & Medicaid Services (CMS) and 10… (Mathematica)
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)
Other Resource | December 2018
Nursing Facility Case-Mix Payment Changes Informational Bulletin
This informational bulletin informs states of two changes that may impact states’ payments for Medicaid beneficiaries in the nursing home setting. (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)
Study Hall Call | August 2018
Technical Operation Considerations for Implementing Enrollment Periods for States Participating in the Capitated Model Financial Alignment Initiative
This webinar provides background on the technical operations updates to Medicare enrollment transactions and processing for dually eligible beneficiaries related to the changes from the Medicare Part C/D final rule released on April 2, 2018. The… (Integrated Care Resource Center)
Study Hall Call | July 2018
Using Value Based Purchasing (VBP) Arrangements to Improve Coordination and Quality of Medicare and Medicaid Nursing Facility Benefits
This webinar provides an overview of two health plans' approaches to Medicare-Medicaid value based purchasing (VBP) with nursing facilities. The presentation also features a panel discussion on Medicare-Medicaid nursing facility VBP with discussants… (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)
Study Hall Call | February 2018
Enrollment Processing and Strategies to Grow Enrollment for States Participating in the Capitated Model Financial Alignment Initiative
This webinar discusses strategies to increase and sustain enrollment into Medicare-Medicaid Plans, including on-going passive enrollment of newly dually eligible individuals and deeming and rapid-re-enrollment strategies to retain coverage for short… (Integrated Care Resource Center)
Study Hall Call | October 2017
Retroactive Enrollment Processing/eRPT for Capitated Model Financial Alignment Demonstrations
This webinar describes the retroactive submission process, including how to use CMS' Electronic Retroactive Processing Transmission (eRPT) application to transmit enrollment transactions to the Retroactive Processing Contractor. (Integrated Care Resource Center)
Brief | September 2017
Value-Based Payment in Nursing Facilities: Options and Lessons for States and Managed Care Plans
This brief describes value-based payment approaches currently used in select states and managed care plans, including the quality and performance measures they use, benchmarks or targets for those measures, and incentives that reward facilities. It… (Integrated Care Resource Center)
Technical Assistance Tool | April 2017
Tips for States Using Enrollment Brokers in the Capitated Financial Alignment Demonstrations: Beneficiary FAQs and Suggested Responses
This technical assistance tool lists questions frequently asked by beneficiaries enrolling in capitated Financial Alignment Initiative demonstrations, and provides potential responses by enrollment brokers' customer service representatives (… (Integrated Care Resource Center)
Other Resource | April 2017
Identifying Newly Eligible Medicare-Medicaid Individuals for Enrollment in Capitated Financial Alignment Demonstrations: Frequently Asked Questions (FAQs)
This document answers questions that states have asked about improving the processes they use to regularly identify prospective Medicare-Medicaid individuals for potential enrollment into their capitated financial alignment demonstrations. (Integrated Care Resource Center)