CMS Medicare-Medicaid Coordination Office (MMCO) December Announcements

The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to announce the following update:

• Training Opportunity: Supporting Individuals with Intellectual and Developmental Disabilities (I/DD) as they Age
• Draft Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”) for Public Comment
• Tip Sheet on State Coverage of Medicare Part B Deductible for Dually Eligible Patients
• Third Annual Report of the Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform

Training Opportunity: Supporting Individuals with Intellectual and Developmental Disabilities (I/DD) as they Age
Date/Time: Wednesday, December 18, 2019, 12:30 PM to 1:45 PM (EST)

This interactive webinar will discuss strategies for providing care to dually eligible individuals with I/DD across the lifespan. Participants will learn about the physical, cognitive, and behavioral changes typical of the aging process, and how these changes may manifest for someone with I/DD. Speakers will share key supports families, health plans, providers and individuals with I/DD may need to manage these types of changes across the life span, as well as describe an integrated approach for responding to the needs of individuals with I/DD as they age

Register at: https://www.resourcesforintegratedcare.com/IntellectualandDevelopmentalDisabilities/2019_IDD_Webinar/Supporting_Individuals_with_IDD_as_they_Age

Intended Audience: This webinar is intended for a wide range of stakeholders – health plan leaders, primary care providers, social workers, care coordinators, case managers, caregivers, and organizations that provide services for dually eligible beneficiaries with I/DD.

Education Credits: Please see the registration link above for detailed information on continuing education opportunities with this training.

Draft Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”) for Public Comment

On December 13, 2019, the Centers for Medicare & Medicaid Services (CMS) released a draft Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”) to states and other stakeholders for review and comment. The draft manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid. States pay Medicare Part B premiums each month for over 10 million individuals and Part A premium for over 700,000 individuals.

This process promotes access to Medicare coverage for low-income older adults and people with disabilities, and it helps states ensure that Medicare pays primary to Medicaid for its dually eligible beneficiaries. Despite the importance of this process, federal guidance on buy-in is out of date. The draft manual reflects current statute, regulation, operations, and systems changes that have evolved over time. Additionally, the draft manual re-organizes content to make it easier for states to discern federal requirements and find information.

The draft manual is available at: https://www.cms.gov/medicare-medicaid-coordination/medicare-medicaid-coordination-office/state-payment-medicare-premiums.

We are welcoming comments through 5:00 p.m. EST on February 29, 2020.

Read the New Tip Sheet on State Coverage of Medicare Part B Deductible for Dually Eligible Patients

The Medicare Part B annual deductible applies to opioid use disorder treatment services. For the majority of individuals dually eligible for Medicaid and Medicare, state Medicaid agencies are liable for the Medicare Part B deductible, subject to certain limits. The new Tip Sheet for Opioid Treatment Program (OTP) Providers Serving Dually Eligible Individuals: State Coverage of the Medicare Part B Deductible gives an introduction to the Part B deductible and how OTPs can get Medicaid payment for this deductible when treating dually eligible individuals. It also gives information about enrolling in Medicare and Medicaid, the Medicare claims crossover process, and how to find additional information.

Third annual report of the Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform

On December 16, the CMS released the third annual report of the “Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform.”

The report builds on last year’s preliminary, but promising, findings for the Initiative. This report, however, did not find evidence that payment reforms led to a consistent pattern of improved outcomes in newly-recruited facilities for Fiscal Year 2018. Facilities that participated in an earlier phase of the Initiative did not show further improvements beyond what was expected based on the trends established during that phase.

For both groups, additional years of data and analysis should provide more definitive insight about Initiative effects.

A brief summary of the report can be found on the CMS web site along with the full evaluation report.