Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This resource reports data on the most recent 12 months of enrollment in capitated model demonstrations under the Financial Alignment Initiative.
On August 26, 2020 from 1:00-2:30 pm ET the Integrated Care Resource Center (ICRC) hosted a Study Hall Call on Medicare-Medicaid Plan (MMP) Enrollment Processing Updates Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA).
The Comprehensive Addiction and Recovery Act of 2016 (CARA) included provisions that give Medicare Prescription Drug Plans and Medicare Advantage plans (including Medicare-Medicaid Plans (MMPs)) tools to address opioid overutilization.
This technical assistance tool describes the regulation that allows Medicare plans that provide prescription drug coverage (including MMPs) to use drug management programs to limit access to certain controlled substances determined to be “frequently abused drugs” for patients who are determined to be at-risk for prescription drug abuse due to the Comprehensive Addiction and Recovery Act of 2016 (CARA).
Related Resources:
This technical assistance tool provides tables describing both general and special election periods relevant to the enrollment of dually eligible indiviuals in drug management programs into Medicare Advantage plans, including Medicare--Medicaid Plans operating in demonstrations under the Financial Alignment Initiative.
Related Resources:
This webinar and accompanying presenation slides provide information on the historical Part A and Part B data across all eligibility responses, as well as an overview of the E&E360 Eligibility and Enrollment Online Portal.
Agenda:
Historical Part A and B Entitlement Data
E&E360 Eligibility and Enrollment Online Portal
The Centers for Medicare & Medicaid Services (CMS) has released an updated version (3.0) of Medicare and Medicaid Plans: A Technical Guide to Eligibility and Enrollment Transaction Processing. Version 3.0 of the technical guide continues to address the CMS Fall 2018 Software changes as documented in the final HPMS notice dated October 4, 2018. A new date field (Beneficiary’s Last use of Dual/LIS Special Election Period (SEP – Election type “L”) has been added to the MBD Eligibility Response layout. The revision history section of the document details this change.
This resource reports data on the most recent 12 months of enrollment in capitated model demonstrations under the Financial Alignment Initiative.
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 participating states contracted with MMPs under capitated arrangements to coordinate Medicare and Medicaid benefits. Beneficiary participation has been lower than anticipated. Only about 29 percent of eligible individuals enrolled in MMPs in 2017.
This resource reports data on the most recent 12 months of enrollment in the capitated model financial alignment demonstrations.