Capitated Model

Medicare-Medicaid Plan (MMP) Enrollment Processing Updates Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

Study Hall Call
8/26/2020

On August 26, 2020 from 1:00-2:30 pm ET  the Integrated Care Resource Center (ICRC) hosted a Study Hall Call on Medicare-Medicaid Plan (MMP) Enrollment Processing Updates Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

Medicare-Medicaid Plan (MMP) Enrollment Restrictions Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

This technical assistance tool describes the regulation that allows Medicare plans that provide prescription drug coverage (including MMPs) to use drug management programs to limit access to certain controlled substances determined to be “frequently abused drugs” for patients who are determined to be at-risk for prescription drug abuse due to the Comprehensive Addiction and Recovery Act of 2016 (CARA).

Related Resources:

Medicare Enrollment Periods and Special Election Periods for Dually Eligible Individuals: Reference Tables

This technical assistance tool provides tables describing both general and special election periods relevant to the enrollment of dually eligible indiviuals in drug management programs into Medicare Advantage plans, including Medicare--Medicaid Plans operating in demonstrations under the Financial Alignment Initiative.

Top Scoring Medicare-Medicaid Plans on Overall Rating of Health Plan: A Snapshot from the 2019 CAHPS Survey

Under the Medicare-Medicaid Financial Alignment Initiative, the Centers for Medicare & Medicaid Services (CMS) is measuring consumer experience in multiple ways, including through beneficiary surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS). As part of the MA-PD CAHPS survey, respondents are asked to rate their health plan on a scale from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible.

Webinar: CMS Historical Part A and B Entitlement Data: Introduction to the E&E360 Portal

On September 25, ICRC hosted the webinar, CMS Historical Part A and B Entitlement Data: Introduction to the E&E360 Portal for states implementing capitated model demonstrations under the Financial Alignment Initiative. The webinar provided a live walk-through of the new E&E360 MMP transaction enrollment portal, presenting real processing scenarios to showcase the benefits and enhancements over the existing Online Processing option.

CMS Historical Part A and B Entitlement Data: Introduction to the E&E360 Portal

Study Hall Call
September 2019

This webinar and accompanying presenation slides provide information on the historical Part A and Part B data across all eligibility responses, as well as an overview of the E&E360 Eligibility and Enrollment Online Portal.

Agenda:

Historical Part A and B Entitlement Data

  • Addition of Historical Part A and B entitlement data across all eligibility responses
  • Review the impact to application systems, introduce updated documents and discuss implementation timelines.

E&E360 Eligibility and Enrollment Online Portal

New ICRC Case Study | The MyCare Ohio Demonstration: Early Successes and Stakeholder Insights on Integrating Care for Dually Eligible Beneficiaries

This case study, developed for the Integrated Care Resource Center, describes: (1) the demonstration’s structure; (2) results achieved to date; and (3) insights on the demonstration’s implementation from the state and other stakeholders. State Medicaid agencies, particularly those looking to integrate care for dually eligible beneficiaries in capitated delivery systems, may find the information described in this brief useful.

The MyCare Ohio Demonstration: Early Successes and Stakeholder Insights on Integrating Care for Dually Eligible Beneficiaries

To provide more integrated, coordinated care for its residents who are dually eligible for Medicare and Medicaid, Ohio is operating a demonstration under the Financial Alignment Initiative offered by the Centers for Medicare & Medicaid Services. This case study describes: (1) the demonstration’s structure; (2) results achieved to date; and (3) insights on the demonstration’s implementation from the state and other stakeholders.

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