CMS Medicare Guidance, Rulemaking, and Public Comments

Update on State Contracting with D-SNPs: The Basics and Meeting New Federal Requirements for 2021

Working with Medicare
07/09/2019

This webinar provides an overview of state strategies for contracting with D-SNPs to improve care coordination and Medicare-Medicaid alignment for dually eligible enrollees. Special attention is given to new federal D-SNP integration standards for 2021 contract year, and how states can help plans to meet these requirements.

Learning Objectives: By the end of this presentation, attendees should be able to:

CMS Releases Updated Manual on State Payment of Medicare Premiums and Related Resource Documents

On September 8, CMS released the updated Manual for State Payment of Medicare Premiums (formerly called “State Buyin Manual”). The 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.

Spotlight: New Interoperability and Patient Access Rule Will Affect Dually Eligible Individuals

On March 9, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule (CMS-9115-F), which is designed to improve patient access to their health information, improve interoperability and encourage innovation, while reducing burden on payers and providers. Two provisions specifically affect dually eligible individuals (see Section VII, Improving the Medicare-Medicaid Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges, and final changes to regulatory text in Parts 406, 407, and 423).

Proposed Addendum to the Part C & D Enrollee Grievances, Organization/ Coverage Determinations, and Appeals Guidance

On July 7, the Centers for Medicare & Medicaid Services (CMS) announced an opportunity for Dual Eligible Special Needs Plans (D-SNPs) and other stakeholders to comment on the proposed Addendum to the Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance (“Part C & D Guidance”).

Comments are due by August 7, 2020.

Integrated Care Updates- June 2020

Hospital Inpatient Prospective Payment Systems (IPPS) Proposed Rule for Released Public Comment

New Data Detailing COVID-19 Impacts on Medicare Beneficiaries

New ICRC Fact Sheet on Integrated Appeals and Grievance Processes for D-SNPs with Exclusively Aligned Enrollment

Transitioning Members of D-SNP Look-Alikes into D-SNPs or Other Plans

MACPAC June Report to Congress

MedPAC June 2020 Report to the Congress

June 2020 Enrollment in Medicare-Medicaid Plans

June 2020 Enrollment in PACE Organizations

New Resources on the ICRC Website

Spotlight: New Interoperability and Patient Access Rule Will Affect Dually Eligible Individuals

On March 9, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule (CMS-9115-F), which is designed to improve patient access to their health information, improve interoperability and encourage innovation, while reducing burden on payers and providers. Two provisions specifically affect dually eligible individuals (see Section VII, Improving the Medicare-Medicaid Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges, and final changes to regulatory text in Parts 406, 407, and 423).

Integrated Care Updates- May 2020

Contract Year 2021 Models for Applicable Integrated Plans: 'Letter about Your Right to Make a Fast Complaint' and 'Appeal Decision Letter’

Contract Year 2021 Medicare Advantage and Part D First Final Rule

Opportunities to Support Enrollment in the Medicare Savings Programs and Extra Help

May 2020 Enrollment in Medicare-Medicaid Plans

May 2020 Enrollment in PACE Organizations

New Resources on the ICRC Website

Key Upcoming Dates

Spotlight: Contract Year 2021 Medicare Advantage and Part D First Final Rule

On May 22, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1) that finalizes a subset of the proposals from the February 18, 2020 proposed rule (85 FR 9002). This first final rule implements certain changes before the CY 2021 bid deadline (due by statute on the first Monday in June) stemming from the Bipartisan Budget Act of 2018 (BBA of 2018) and the 21st Century Cures Act.

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