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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.

(-) Oversight and Monitoring

Displaying 1 - 15 of 17

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)
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)
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)
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)
Study Hall Call | May 2015
State Use of Medicare Advantage Encounter Data: Perspectives from Two States
Provides an overview of how state Medicaid agencies can obtain and use Medicare Advantage encounter data and shares insights from Arizona's and Tennessee's experiences with this process. (Integrated Care Resource Center)
Brief | May 2015
The Star Rating System and Medicare Advantage Plans
This brief examines how star rating are calculated and considerations around how differences among beneficiary populations should be recognized. (National Health Policy Forum)
Study Hall Call | February 2015
State Perspectives on Contracting with Dual Eligible Special Needs Plan
This presentation highlights the ICRC technical assistance tool State Contracting with Medicare Advantage Dual Eligible Special Needs Plans: Issues and Options and features a moderated panel discussion among representatives of three states (… (Integrated Care Resource Center)
Brief | December 2014
Measuring Up: A Novel Approach to Assessing State Oversight of Medicaid Managed Care
This brief assesses Washington State's oversight of Medicaid managed care plan performance under the state's 1915 (b) waiver by quantifying monitoring practices and comparing them to benchmarks inside and outside of Washington State. (Mathematica)
Study Hall Call | September 2014
State Monitoring and Oversight of Managed Long-Term Services and Supports Care Programs
In this presentation, an ICRC speaker describes the basic principles of MLTSS program oversight and state performance monitoring practices for Medicaid MLTSS programs. In addition, a speaker from Texas offers operational insight on oversight of the… (Integrated Care Resource Center)
Study Hall Call | May 2014
Medicare Advantage D-SNP Contract Oversight and Quality Monitoring
This webinar summarizes a discussion among states, the Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors, and ICRC about Medicare Advantage Dual Eligible Special Needs Plan contract oversight and quality… (Integrated Care Resource Center)
Other Resource | May 2014
Medicare Advantage D-SNP Contract Oversight and Quality Monitoring
This document summarizes a telephone discussion among states, CMS, the National Association of Medicaid Directors, and ICRC about Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) contract oversight and quality monitoring procedures. (Integrated Care Resource Center)
Other Resource | January 2014
Medicare Advantage Network Adequacy Requirements, D-SNPs, and State Contracting Options
This document summarizes a telephone discussion among states, CMS, the National Association of Medicaid Directors, and ICRC regarding Medicare Advantage network adequacy requirements and their application to D-SNPs. (Integrated Care Resource Center)
Other Resource | December 2013
Ready, Set, Go! The Readiness Review Process for Care Coordination and Provider Network Adequacy in Five States
This report spotlights the approaches used by five states - Arizona, Minnesota, Tennessee, Texas, and Wisconsin - to ensure managed care organizations are ready to provide care coordination services to consumers and adequate access to needed long-… (AARP Public Policy Institute)