Capitated Model

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, MS 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.

Technical Guide for Medicare-Medicaid Plan Enrollment v 3.0

The Medicare & Medicaid Plan Eligibility and Enrollment Guide describes the interface to the Infocrossing applications for Medicare Eligibility verification and Enrollment submission to the CMS MARx systems. Version 3.0 of the MMP Technical Guide has been updated to reflect the addition of a date field for Beneficiary’s Last Use of Dual/LIS Special Election Period (SEP - Election Type “L”).

Technical Operation Considerations for Implementing Enrollment Periods for States Participating in the Capitated Model Financial Alignment Initiative

Study Hall Call

This webinar provides background on the technical operations updates to Medicare enrollment transactions and processing for dually eligible beneficiaries related to the changes from the Medicare Part C/D final rule released on April 2, 2018. The presentation also discusses the technical operation considerations for enrollment of beneficiaries in Medicare-Medicaid Plans (MMPs).

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