Other Resource

This memo describes the annual capitation rate for each Medicare Advantage payment area for CY 2021 and the risk and other factors to be used in adjusting these rates.

In response to the unique circumstances resulting from D-SNPs’ and states’ priority focus on reducing the risks of COVID-19 transmission and maintaining continuity of operations, this memorandum outlines updated CMS processes for review and approval of state Medicaid agency contracts (SMACs) for contract year 2021. The goal is to provide D-SNPs and states with as much additional time as possible to execute contracts consistent with these new regulatory requirements prior to the January 1, 2021, effective date.

This Centers for Medicare & Medicaid Services (CMS) final rule strengthens patient protections, improves care coordination, and provides administrative flexibilities and regulatory relief for Programs of All-Inclusive Care for the Elderly (PACE). The final rule removes redundancies and eliminates outdated information, which will reduce administrative burden on PACE organizations, and allow clinicians and other care providers to focus more of their time on patients.

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 for Medicaid and Medicare. The Informational Bulletin clarifies that states do not need to require a Medicare denial for DMEPOS that Medicare routinely denies as non-covered under the Medicare DME benefit.

This State Medicaid Director Letter highlights ten opportunities for states to better serve individuals dually eligible for Medicare and Medicaid.

In 2017, there were 12 million individuals dually eligible for Medicare and Medicaid. This fact sheet provides information on their reasons for Medicare eligibility, costs of care, and enrollment in managed care as well as the proportion of these beneficiaries who receive their care through arrangements that integrate their Medicare and Medicaid benefits.

The ability to direct and manage their own services and supports is important to many individuals who need the home- and community-based services (HCBS) provided through state Medicaid programs. These self-directed models may also be known as "consumer direction" and "participant direction" when referring to specific states' programs. In these models, individuals direct many or all of their own HCBS, including selecting and managing direct service workers and/or managing a budget (known in some states as a service cost maximum) for needed services.

This document describes a Microsoft Access tool to prioritize information in the MARx system Daily Transaction Reply Report, and it explains states can use it to improve the timeliness and efficiency of their demonstration enrollment processes.

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.

This document describes the process that states and health plans participating in the capitated financial alignment demonstrations use to submit information to CMS' MARx systems.