Capitated Model

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.

New Opportunities to Test Innovative Models of Integrated Care for Dually Eligible Individuals

On April 24, 2019, CMS released a State Medicaid Director Letter that invites states to partner with CMS to test innovative approaches to better serve individuals who are dually eligible for Medicare and Medicaid. The three new opportunities include: capitated Financial Alignment models; (2) managed fee-for-service Financial Alignment models; and (3) state-specific models. 

Technical Guide for Medicare-Medicaid Plan Enrollment v 3.0

The Centers for Medicare & Medicaid Services (CMS) has released an updated version (3.0) of Medicare and Medicaid Plans: A Technical Guide to Eligibility and Enrollment Transaction Processing. Version 3.0 of the technical guide continues to address the CMS Fall 2018 Software changes as documented in the final HPMS notice dated October 4, 2018. A new date field (Beneficiary’s Last use of Dual/LIS Special Election Period (SEP – Election type “L”) has been added to the MBD Eligibility Response layout. The revision history section of the document details this change.

An Exploration of Consumer Advisory Councils within Medicare-Medicaid Plans Participating in the Financial Alignment Initiative

The Center for Consumer Engagement in Health Innovation released a report The Biggest Value is Getting the Voice of the Member describing its findings on the composition, function, and impact of the Consumer Advisory Councils operating within Medicare-Medicaid Plans (MMPs) operating in capitated model demonstrations under the Financial Alignment Initiative. The report covers topics including, recruitment and training of consumer members, accommodations to help consumers participate, and ensuring representativeness and diversity.

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