The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to share the following updates:
- CMS proposed rule on dual eligible special needs plans – Medicaid integration and unified appeals and grievance processes
- ASPE Request for Information: IMPACT ACT Research Study - Provider and Health Plan Approaches to Improve Care for Medicare Beneficiaries with Social Risk Factors
- New opioid use indicators in the Chronic Condition Warehouse
- Data brief on national trends in high-dose chronic opioid utilization (2006-2015)
- Training opportunities:
- Promising Practices for Meeting the Needs of Dually Eligible Older Adults with Schizophrenia
- Innovations in Member Engagement in Rural Areas
CMS Proposed Rule on Dual Eligible Special Needs Plans – Medicaid Integration and Unified Appeals and Grievance Processes
In a proposed rule issued October 26, 2018, CMS included provisions to implement certain provisions of the Bipartisan Budget Act of 2018 related to dual eligible special needs plans (D-SNPs):
In a proposed rule issued October 26, 2018, CMS included provisions to implement certain provisions of the Bipartisan Budget Act of 2018 related to dual eligible special needs plans (D-SNPs):
- CMS is proposing to establish new minimum criteria for Medicare and Medicaid integration in D-SNPs for Contract Year 2021 and subsequent years. Pursuant to the requirements in the Bipartisan Budget Act, we propose to require that D-SNPs meet the integration criteria either by (1) covering Medicaid long-term services and supports and/or behavioral health services through a capitated payment from a state Medicaid agency; or (2) notifying the state Medicaid agency (or its designee) of hospital and skilled nursing facility admissions for at least one group of high-risk full-benefit dual eligible individuals, as determined by the state Medicaid agency.
- CMS is proposing rules to unify Medicare and Medicaid grievance and appeals processes for certain D-SNPs and affiliated Medicaid managed care plans. The processes would apply to D-SNPs with fully aligned enrollment and the affiliated Medicaid managed care organization, where one organization is responsible for managing Medicare and Medicaid benefits for all enrollees. In such D-SNPs, enrollees will have simpler, more straightforward grievance and appeals processes. The Bipartisan Budget Act of 2018 requires compliance with unified grievance and appeal procedures beginning in Contract Year 2021.
Public comments are due by December 31, 2018. For a fact sheet on the proposed rule, please visit: https://www.cms.gov/Newsroom/
ASPE Request for Information: IMPACT ACT Research Study - Provider and Health Plan Approaches to Improve Care for Medicare Beneficiaries with Social Risk Factors
On October 16, 2018, the U.S. Department of Health & Human Services, Office of The Assistant Secretary for Planning and Evaluation (ASPE) released a Request for Information (RFI), IMPACT Act Research Study: Provider and Health Plan Approaches to Improve Care for Medicare Beneficiaries with Social Risk Factors.
On October 16, 2018, the U.S. Department of Health & Human Services, Office of The Assistant Secretary for Planning and Evaluation (ASPE) released a Request for Information (RFI), IMPACT Act Research Study: Provider and Health Plan Approaches to Improve Care for Medicare Beneficiaries with Social Risk Factors.
The RFI focuses on one aspect of the larger study mandated by Congress in the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; requiring ASPE to evaluate the effect of individuals’ socioeconomic status on quality measures and measures of resource use under the Medicare program. The first Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Payment Programs was released in December of 2016, and focused on socioeconomic information currently available in Medicare data. Following up on ASPE’s first report, HHS is interested in:
- How plans and providers serving Medicare beneficiaries identify beneficiaries with social risk factors
- Approaches plans and providers have used to address the needs of beneficiaries with social risk factors
- Evidence regarding the impact of these approaches on quality outcomes and the total cost of care
- Ways in which plans and providers disentangle beneficiaries’ social and medical risks and address each
Responses are due November 16, 2018 by email to ASPEImpactStudy@hhs.gov. The RFI is available here: https://aspe.hhs.gov/social-
New Opioid Use Indicators in the Chronic Condition Warehouse
CMS has created four new Chronic Conditions Data Warehouse (CCW) indicators for researchers to monitor and better understand opioid use disorder (OUD) within the Medicare, Medicaid, and dually eligible populations. More information can be found at https://www.ccwdata.org/web/
CMS has created four new Chronic Conditions Data Warehouse (CCW) indicators for researchers to monitor and better understand opioid use disorder (OUD) within the Medicare, Medicaid, and dually eligible populations. More information can be found at https://www.ccwdata.org/web/
Data Brief on National Trends in High-Dose Chronic Opioid Utilization among Dually Eligible and Medicare-only Beneficiaries (2006-2015)
CMS released a data brief, Data Analysis Brief: National Trends in High-dose Chronic Opioid Utilization among Dually Eligible and Medicare-only Beneficiaries (2006-2015), which provides a baseline understanding of high-dose chronic (HDC) prescription opioid use among dually eligible beneficiaries over the ten-year period from 2006 to 2015. The brief underscores that dually eligible individuals receive prescription opioids at HDC levels at higher rates than those with Medicare-only and that these differences are driven mainly by disability. The data brief can be found here: https://www.cms.gov/Medicare-
CMS released a data brief, Data Analysis Brief: National Trends in High-dose Chronic Opioid Utilization among Dually Eligible and Medicare-only Beneficiaries (2006-2015), which provides a baseline understanding of high-dose chronic (HDC) prescription opioid use among dually eligible beneficiaries over the ten-year period from 2006 to 2015. The brief underscores that dually eligible individuals receive prescription opioids at HDC levels at higher rates than those with Medicare-only and that these differences are driven mainly by disability. The data brief can be found here: https://www.cms.gov/Medicare-
Training Opportunity: Promising Practices for Meeting the Needs of Dually Eligible Older Adults with Schizophrenia
Date/Time: November 6, 2018 from 2:30-4:00pm (EDT)
Register here: https://www.
Date/Time: November 6, 2018 from 2:30-4:00pm (EDT)
Register here: https://www.
Older adults who are dually eligible for Medicare and Medicaid have higher rates of schizophrenia and other psychotic disorders than older adults with Medicare only.[1] This interactive webinar will discuss how to identify common symptoms of schizophrenia among older adults, identify promising practices related to treatment options and care coordination, and demonstrate practical strategies for meeting beneficiary needs. Speakers, including a family caregiver, will discuss firsthand experiences, lessons learned, and strategies to improve care for dually eligible older adults with schizophrenia.
Intended Audience: This webinar is intended for a wide range of stakeholders – front-line staff at social service agencies, providers and health care professionals (such as physicians, psychiatrists, psychologists, nurses, social workers, counselors), Medicare-Medicaid plans, dual eligible special needs plans, managed long-term services and supports programs, and consumer organizations.
CME/CE Credit Information: The Centers for Medicare & Medicaid Services (CMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CMS is also accredited by the International Association for Continuing Education and Training (IACET) to offer continuing education credit.
Training Opportunity: Innovations in Member Engagement in Rural Areas
Date/Time: November 27, 2018 from 1:00-2:00pm (EDT)
Register here: https://www.
Date/Time: November 27, 2018 from 1:00-2:00pm (EDT)
Register here: https://www.
Twenty-seven percent (27%) of individuals who receive coverage through both Medicare and Medicaid live in rural areas.[2] Dually eligible beneficiaries living in rural areas often contend with distance and transportation barriers, a shortage of primary care providers, and limited access to specialty care. This webinar will focus on how plans conduct initial outreach, build connections, and establish trust with rural dually eligible enrollees, as well as engagement strategies to assist them in managing their health.
Intended Audience: This webinar is intended for staff of Medicare-Medicaid plans, dual eligible special needs plans, and Medicaid managed care plans who are interested in engaging their members living in rural areas in plan services and helping these members manage their health needs.
CME/CE Credit Information: The Centers for Medicare & Medicaid Services (CMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CMS is also accredited by the International Association for Continuing Education and Training (IACET) to offer continuing education credit.
[1] Medicaid and CHIP Payment and Access Commission. (2015). Chapter 4: Behavioral Health in the Medicaid Program – People, Use, and Expenditures.
[2] Medicare Payment Advisory Commission (MEDPAC). (2017, June). Dual-eligible beneficiaries in A Data Book: Health care spending and the Medicare program (pp 37-49). Retrieved from http://www.medpac.gov/docs/
[2] Medicare Payment Advisory Commission (MEDPAC). (2017, June). Dual-eligible beneficiaries in A Data Book: Health care spending and the Medicare program (pp 37-49). Retrieved from http://www.medpac.gov/docs/
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