The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to share the following updates:
- New Video on Successful Member Engagement in Health Plan Governance: Listening to the Voice of Dually Eligible Beneficiaries: Successful Member Advisory Councils
- Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for State Medicaid Agency Contracts with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) for Contract Year 2021
- New Medicare Opioid Treatment Program Benefit Implications for Dually Eligible Individuals
- 2020 Medicare Parts A & B Premiums and Deductibles
- Help Raise Awareness and #FightFlu
New Video on Successful Member Engagement in Health Plan Governance: Listening to the Voice of Dually Eligible Beneficiaries: Successful Member Advisory Councils
By gathering member and caregiver feedback, health plans can ensure that policies and procedures are responsive to the needs, preferences, and values of plan members and their families and caregivers. One of the ways health plans engage members dually eligible for Medicare and Medicaid is by including members in plan governance through member advisory councils. A new video is available from the Resources for Integrated Care highlighting promising practices for implementing successful member advisory councils, including member recruitment and training and feedback strategies.
This video features interviews with members, a caregiver, health plan staff, and health plan executive leadership sharing their perspectives on successful member advisory councils.
Intended Audience
This video is intended for staff of Medicare-Medicaid Plans; Medicaid plans; Medicare Advantage plans; Special Needs Plans (SNPs), including Dual Eligible Special Needs Plans (D-SNPs); PACE organizations; and other health plans interested in incorporating the perspectives of consumers.
Access the video at: https://www.
Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for State Medicaid Agency Contracts with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) for Contract Year 2021
On November 14, the Centers for Medicare & Medicaid Services (CMS) released an Informational Bulletin to provide states with important information to consider when updating their Contract Year 2021 contracts with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs).
On April 16, CMS issued a final rule implementing new statutory provisions from the Bipartisan Budget Act of 2018 that strengthened D-SNP Medicare-Medicaid integration requirements and unified Medicare and Medicaid grievance and appeals procedures for some D-SNPs beginning in 2021. As highlighted in this Informational Bulletin, states play an essential role in D-SNP implementation of these new requirements.
CMS will continue to provide technical assistance to states and D-SNPs to help with implementation of these new requirements. The CIB is available at https://www.medicaid.gov/
New Medicare Opioid Treatment Program Benefit Implications for Dually Eligible Individuals
On November 1, CMS issued the Calendar Year (CY) 2020 Medicare Physician Fee Schedule final rule, including regulations for Medicare to pay Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services provided to people with Medicare Part B.
For dually eligible individuals receiving OTP services through Medicaid in one of 42 states that cover the benefit in their state plan amendment, starting January 1, 2020, Medicare will be the primary payer for OTP.
As we note in the final rule, CMS will issue guidance to states to clarify that Medicaid must continue to pay OTP providers who are enrolled in Medicaid and not yet enrolled in Medicare (to the extent the service is covered in the state plan), and to offer suggestions on ways State Medicaid Agencies can uphold their responsibilities as the payer of last resort while promoting continuity of care for dually eligible individuals.
CMS is conducting outreach directly to OTP providers to let them know about this new Medicare benefit and how to enroll in Medicare. OTP providers should enroll in Medicare now to be able to bill Medicare for OTP services beginning January 1, 2020.
The CMS OTP webpage will have the most current information, education, and upcoming events on the new benefit.
2020 Medicare Parts A & B Premiums and Deductibles
On November 8, CMS released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.
Medicare Part A Premiums/Deductibles
Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.
The Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital will be $1,408 in 2020, an increase of $44 from $1,364 in 2019.
Medicare Part B Premiums/Deductibles
The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.
The fact sheet is available at https://www.cms.gov/newsroom/
Medicare Savings Programs
Beneficiaries who face challenges paying for their health care may quality for one of 4 kinds of Medicare Savings Programs to help for Medicare premiums and other costs. Additional information is available at https://www.medicare.gov/your-
Help Raise Awareness and #FightFlu
On Wednesday, December 4, 2019 we invite you to join us on social media to promote flu vaccinations using the hashtag #FightFlu! We need your help getting the message out that getting an annual flu vaccination is important for individuals and their families, care providers, and community members.
Web tools and social media content for National Influenza Vaccine Week can be accessed from the Centers for Disease Control and Prevention’s website at https://www.cdc.gov/flu/
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