Medicare-Medicaid Integration Study Hall Calls

This webinar series provides a virtual learning opportunity for states implementing capitated or managed fee-for-service Medicare-Medicaid financial alignment demonstration models, or other programs that advance Medicare-Medicaid integration. Topics have included enrollment, program monitoring, member outreach, readiness reviews, and provider network development. Any state pursuing an integrated model for Medicare-Medicaid enrollees may participate. For more information, contact Michelle Soper, Center for Health Care Strategies, at msoper@chcs.org.

Webinar slides and audio recordings are available below. Click on the column headings to sort the list by topic, call title, date, or description.

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Topic Title and Link Date Description
Enrollment Partnering with SHIPs to Improve Care Slides Recording Mar 2018 Provides an overview of partnerships between Medicaid agencies and SHIPs in both PA and SC.
Stakeholder Engagement Partnering with SHIPs to Improve Care Slides Recording Mar 2018 Provides an overview of partnerships between Medicaid agencies and SHIPs in both PA and SC.
Enrollment Infocrossing's Medicare Solution Web Portal Slides Recording Mar 2018 Provides a live walk-through of the tools and various reports available to states on the website, www.Medicare-Solution.com, including: the submission of individual enrollment related transactions, enrollment transaction history reports, reconciliation reports, available MARx files and reports, the MMP Prospective Dual File, and the enrollment resource toolkit.
Enrollment Enrollment Processing and Strategies to Grow Enrollment for States Participating in the Capitated Model Financial Alignment Initiative Slides Recording Feb 2018 Discusses strategies to increase and sustain enrollment into Medicare-Medicaid Plans, including on-going passive enrollment of newly dually eligible individuals and deeming and rapid-re-enrollment strategies to retain coverage for short-term loss of Medicaid.
Enrollment Retroactive Enrollment Processing/eRPT for Capitated Model Financial Alignment Demonstrations Slides Recording Oct 2017 Describes the retroactive submission process, including how to use CMS' Electronic Retroactive Processing Transmission (eRPT) application to transmit enrollment transactions to the Retroactive Processing Contractor.
Care Coordination and Management  Exploring Community-Based Organizations' (CBOs) Role as a Delivery System Partner to Support Vulnerable Populations Slides Recording Mar 2017 Provides an overview of the Administration for Community Living's initiative to improve the business acumen of community-based organizations (CBOs) and features perspectives from a CBO and a health plan on building contractual relationships with integrated programs.
Enrollment Identifying Newly Eligible Medicare-Medicaid Enrollees for Enrollment in Capitated Financial Alignment Demonstrations Slides Recording Nov 2016 Describes an opportunity identify prospective Medicare-Medicaid enrollees for enrollment into capitated financial alignment demonstrations and provides perspectives from Massachusetts and Michigan on states' use of this process. Related Resource
Enrollment Data-Driven Strategies - Analysing Opt-Outs and Engaging Beneficiaries and Providers Slides Jul 2016 Features state experiences using data-driven strategies to analyze opt-outs and engage beneficiaries and providers in financial alignment demonstrations. Summary
Enrollment Using Microsoft Access to Simplify Enrollment Reconciliation in Capitated Financial Alignment Demonstrations Slides Recording Mar 2016 Introduces state enrollment staff to a tool to help prioritize transaction reply codes and simplify enrollment reconciliation. Related Resource
Oversight and Plan Management  Overview of State Considerations for Medicaid Managed Long-Term Services and Supports (MLTSS) Rate Setting Slides Recording Mar 2016 Features an overview of MLTSS rate setting basics, shares initial findings from a project on Medicaid MLTSS rate setting, and also includes a facilitated discussion with an expert actuary and state representatives from Tennessee and Texas. Summary
Provider Engagement Provider Engagement and Incentives in Care Management Slides Recording Dec 2015 Features presentations on promising practices for information sharing and building relationships between providers, plans, and the state of Minnesota to optimize care management.
Oversight and Plan Management  Building State, Health Plan and Nursing Facility Relationships in Integrated Medicare-Medicaid Programs Slides Recording Jul 2015 Discusses successful approaches to building collaborative working relationships between states, health plans, and nursing facility providers in integrated Medicare-Medicaid programs. Summary
Care Coordination and Management  Reducing Avoidable Hospitalizations Among Nursing Facility Residents: Three Perspectives Slides Recording Jun 2015 Features perspectives and lessons learned from two Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) – HealthPartners in Minnesota and Bridgeway Health Solutions in Arizona – and from The Curators of the University of Missouri, one of seven organizations participating in the CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents.
Data State Use of Medicare Advantage Encounter Data: Perspectives from Two States Slides Recording May 2015 Provides an overview of how state Medicaid agencies can obtain and use Medicare Advantage encounter data and shares insights from Arizona's and Tennessee's experiences with this process.
Enrollment Passive Enrollment of the Newly Medicare-Medicaid Eligible Population into MMPs Slides Recording Apr 2015 Explores strategies to passively enroll newly dually eligible populations into Medicare-Medicaid Plans (MMPs), especially those individuals who were enrolled in Medicaid before becoming eligible for Medicare.
Enrollment MMP Enrollment Assistance – Introduction to the Infocrossing Web Portal Slides Recording Mar 2015 Includes information about the Infocrossing Web Portal, which supports enrollment processing for Medicare-Medicaid Plans (MMPs), important tools that are available for states, an overview of Infocrossing’s MMP technical guide updates, and upcoming CMS software changes.
D-SNPs State Perspectives on Contracting with Dual Eligible Special Needs Plans Slides Recording Feb 2015 Highlights D-SNP contracting options and shares Tennessee’s, Minnesota’s, and New Jersey’s approaches to Dual Eligible Special Needs Plan (D-SNP) contracting, strategies for developing relationships with D-SNPs, and thoughts on other ways states can use D-SNP contracts to advance integrated care for Medicare-Medicaid enrollees. 
Oversight and Plan Management  Building and Validating LTSS Provider Networks Slides Recording Jan 2015 Examines strategies for states establishing Medicaid managed long-term services and supports (MLTSS) or integrated care programs to ensure that health plans develop LTSS provider networks to address beneficiaries’ diverse needs.
Enrollment Enrollment Processing and Technical Assistance for Medicare-Medicaid Demonstration States Slides Recording Dec 2014 Reviews the steps in the Medicare-Medicaid Plan enrollment process for states participating in capitated model financial alignment demonstrations and highlights lessons about the enrollment process from states that began enrollment in 2013 and 2014.
Provider Engagement Engaging Providers in Integrated Care Programs Slides Recording Nov 2014 Highlights tips for engaging providers in integrated care programs; describes Virginia’s approach to provider engagement for its financial alignment demonstration; and reviews Independent Care Health Plan’s (iCare’s) approach to provider relationships. 
Marketing Integrated Marketing Rules and Practices for Medicare and Medicaid Managed Care Slides Recording Oct 2014 Outlines the differences between Medicare and Medicaid marketing requirements and opportunities for better alignment and offers lessons from the roll out of Massachusetts’ integrated marketing process.
Appeals Improving Coordination of Home Health Services and Durable Medical Equipment for Medicare-Medicaid Enrollees in the Financial Alignment Initiative Slides Recording Sep 2014 Highlights issues with overlapping coverage for home health services and durable medical equipment and describes the Health Plan of San Mateo’s approach to coordinating these services, including operating protocols, denials of coverage, grievances and appeals, and encounter data and performance reporting.
Benefit Integration  Improving Coordination of Home Health Services and Durable Medical Equipment for Medicare-Medicaid Enrollees in the Financial Alignment Initiative Slides Recording Sep 2014 Highlights issues with overlapping coverage for home health services and durable medical equipment and describes the Health Plan of San Mateo’s approach to coordinating these services, including operating protocols, denials of coverage, grievances and appeals, and encounter data and performance reporting.
Oversight and Plan Management  State Monitoring and Oversight of Managed Long-Term Services and Supports Care Programs Slides Recording Sep 2014 Describes the principles of managed long-term services and supports program oversight, and offers operational insight on oversight of Texas’ STAR+PLUS program.
Participant Direction Participant Direction in Integrated Care Programs Slides Recording Jul 2014 Examines participant direction and findings from a study of contract language by the National Resource Center for Participant-Directed Services; also describes how Massachusetts' Commonwealth Care Alliance supports members who wish to self-direct services.
D-SNPs Medicare Advantage D-SNP Contract Oversight and Quality Monitoring Summary May 2014 Summarizes a discussion among states, the Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors, and ICRC about Medicare Advantage Dual Eligible Special Needs Plan contract oversight and quality monitoring procedures.
Enrollment An Update on Enrollment Processes in the Capitated Model Financial Alignment Demonstrations Slides Recording May 2014 Describes the process that states will use to send eligibility and enrollment information between CMS and Medicare-Medicaid Plans participating in the capitated model financial alignment demonstrations.
Evaluations Update on Evaluations of Financial Alignment Demonstrations Slides Recording Apr 2014 Details RTI’s evaluation of state demonstrations under the Financial Alignment Initiative, including a review of the State Data Reporting System and the “finder file” for the evaluation.
D-SNPs Medicare Advantage Enrollment Processes: D-SNP New Entries, Service Area Changes, Terminations, Non-Renewals, and Seamless Conversions Summary Mar 2014 Summarizes a discussion among states, Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors, and ICRC regarding Medicare Advantage Dual Eligible Special Needs Plans non-renewals, service area changes, terminations, new entries, seamless conversions, and passive enrollment.
D-SNPs Medicare Advantage Network Adequacy Requirements, D-SNPs, and State Contracting Options Summary Jan 2014 Summarizes a discussion among states, Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors, and ICRC regarding Medicare Advantage network adequacy requirements and their application to Dual Eligible Special Needs Plans.
Benefit Integration  Hospital to Community Transitions for Medicare-Medicaid Enrollees Slides Recording Dec 2013 Describes the approaches of two health plans in Arizona and Minnesota to managing care transitions by Medicare-Medicaid enrollees and other beneficiaries with complex conditions.
Care Coordination and Management  Hospital to Community Transitions for Medicare-Medicaid Enrollees Slides Recording Dec 2013 Describes the approaches of two health plans in Arizona and Minnesota to managing care transitions by Medicare-Medicaid enrollees and other beneficiaries with complex conditions.
Appeals Integrated Denial Notice Slides Recording Nov 2013 Provides background on the integrated denial notice and discusses the applicability of the integrated denial notice outside of the financial alignment demonstrations, using New York as an example.
Oversight and Plan Management  Three-Way Contracting - The Massachusetts Experience Slides Oct 2013 Provides CMS’ and MassHealth’s perspectives on the challenges and successes of the three-way contracting process in Massachusetts, including discussion of managing timeframes and interacting with health plans.
Marketing Marketing and Member Materials Slides Recording Jul 2013 Reviews financial alignment demonstration marketing principles and marketing guidance for capitated demonstration states and describes marketing for MassHealth’s One Care program.
Enrollment Enrollment Guidance Slides Jun 2013 Describes the process for beneficiary enrollment in Medicare-Medicaid Plans and the process that states and health plans participating in capitated demonstration models will use to submit information to CMS’ MARx systems.
Oversight and Plan Management  The Three Way Contract Slides May 2013 Reviews the structure of the three-way contract discusses the interplay between the contract and other demonstration documents, and describes the contract development and review processes.
Appeals Integrated Appeals & Grievances Slides Apr 2013 Provides an overview of the Medicare appeals process and gives examples of the integrated Medicare/Medicaid appeals processes proposed in California, Massachusetts, Ohio, and New York.
Evaluations Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals Slides Mar 2013 Describes the goals of RTI’s evaluation, the quality measures and data sources to be used, and the analysis plan.
Participant Direction Consumer Direction in Managed Long-Term Services and Supports Programs Slides Recording Mar 2013 Explains participant direction and how it can be included in contract language; also describes how Arizona implemented consumer direction in its long-term care system.
Ombudsman Use of Ombudsman Services in Medicaid Managed Care Programs Slides Jan 2013 Provides a brief history of ombudsman programs in Texas and Vermont and describes the Medicaid managed care ombudsman programs in these states.
Oversight and Plan Management  Rate Setting for Capitated Medicaid Managed Long-Term Services and Supports Slides Jan 2013 Describes the objectives of the rate-setting process in Medicaid managed long-term services and supports programs, including the basic approach, rate structure, and risk mitigation strategies.
Data Update on Using Medicare Data to Integrate Care for Medicare-Medicaid Enrollees Slides Dec 2012 Describes the process to request Medicare data and how New York and Washington are using these data.
Stakeholder Engagement A Transparent and Inclusive Stakeholder Process Slides Sep 2012 Described California’s stakeholder engagement process for its financial alignment demonstration including the development of its Communications Toolkit.
Care Coordination and Management  Training Strategies and Lessons Learned Slides Aug 2012 Discusses the training strategies and lessons learned from the implementation of Tennessee’s Medicaid managed long-term services and supports program.
Oversight and Plan Management  Training Strategies and Lessons Learned Slides Aug 2012 Discusses the training strategies and lessons learned from the implementation of Tennessee’s Medicaid managed long-term services and supports program.
Oversight and Plan Management  Readiness Review for Implementation of a Medicaid Managed Long-Term Services and Supports Program Slides Jul 2012 Describes the readiness review process that Tennessee used with health plans participating in its Medicaid managed long-term services and supports program.