Financial Alignment Demonstrations

State Approaches to Developing and Operating Ombudsman Programs for Demonstrations under the Financial Alignment Initiative

Ombudsman programs can offer beneficiary protections as part of Medicaid managed care programs. These programs are particularly important for beneficiaries with complex physical and behavioral health conditions, including many dually eligible individuals. For the demonstrations under the Financial Alignment Initiative, the Centers for Medicare & Medicaid (CMS) and states incorporated ombudsman programs to help to resolve enrollees’ problems and alert Medicare-Medicaid Plans (MMPs), states, and CMS of emerging trends and issues.

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:

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

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

Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches

This MACPAC report reviews and analyzes care coordination requirements in the managed care organization contracts of nine states participating in demonstrations under the Financial Alignment Initiative, 10 states that contract with Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and eight states that contract with Dual Eligible Special Needs Plans (D-SNPs) that are required to have companion plans that provide Medicaid managed longterm services and supports (MLTSS plans). 

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.

Integrated Care Updates - May 2019

May 2019 Contents:

  • CMS Releases PACE Final Rule
  • New Evaluation Reports for Demonstrations under the Financial Alignment Initiative
  • Upcoming Resources for Integrated Care (RIC) Webinars
  • CMS Releases 2017 Medicaid Managed Care Enrollment Reports
  • May 2019 Enrollment in Medicare-Medicaid Plans (MMPs)
  • May 2019 Enrollment in PACE Organizations