Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
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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.
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
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 example… (Integrated Care Resource Center)
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)
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) publicly… (Integrated Care Resource Center)
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, and… (Integrated Care Resource Center)
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)
This report, mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 ("IMPACT Act"), details research conducted on the relationships between social rick factors and performance in Medicare's value-based… (Office of the Assistant Secretary for Planning and Evaluation [ASPE])
This report presents a conceptual social risk factor framework, and details the results of a literature review linking social risk factors to health care outcomes important to Medicare payment and quality programs.
(National Academies of Sciences, Engineering, and Medicine)
This brief describes approaches that states have used to communicate early integrated care program results. Strategies discussed include developing program indicator dashboards, disseminating beneficiary experience data, and sharing success stories.
(Center for Health Care Strategies)
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)
This webinar explores Medicare Advantage plans' experience with the Star Ratings system, considers whether the system has served to drive quality improvement, how accurately it reflects plan management of quality and service, and what might… (National Health Policy Forum)