Grievances and Appeals

Integrated Care Updates - January 2020

January 2020 Contents:

New ICRC Flow Charts Compare Existing and New Unified Appeals and Grievance Processes for Individuals Enrolled in Applicable Integrated D-SNPs
CMS Releases Additional Guidance on D-SNP Integration Requirements
CMS Releases the 2021 Medicare Advantage Advance Notice
MACPAC Considers Policy Options to Better Integrate Care for Dually Eligible Individuals
January 2020 Enrollment in Medicare-Medicaid Plans
January 2020 Enrollment in PACE Organizations
Key Upcoming Dates

Appeals and Grievances: Comparisons of Existing and New Integrated Processes for Individuals Enrolled in Applicable Integrated Plans

Beginning in 2021, Dual Eligible Special Needs Plans (D-SNPs) with exclusively aligned enrollment must begin using integrated appeals and grievance processes. The flowcharts in this resource are designed to help states, health plans, and other stakeholders understand the differences between existing Medicare and Medicaid appeal and grievance processes and the new integrated appeal and grievance processes established at 42 CFR Part 422 Subpart M for fully and highly integrated D-SNPs with exclusively aligned enrollment.

Integrated Denial Notice

Study Hall Call

November-13

This webinar provides background on the integrated denial notice and discusses the applicability of the integrated denial notice outside of the financial alignment demonstrations, using New York as an example.

Integrated Appeals & Grievances

Study Hall Call

April-13

Provides an overview of the Medicare appeals process and gives examples of the integrated Medicare/Medicaid appeals processes proposed in California, Massachusetts, Ohio, and New York.

Proposed Model for Integrating the Medicare and Medicaid Appeals Processes

This document describes a proposed strategy to integrate the Medicare and Medicaid appeals processes for D-SNPs.

View Resource:

View Resource

Integrated Appeals Processes for Medicare-Medicaid Enrollees: Lessons from States

This brief explores opportunities for states to develop an integrated appeals process, whether through a D-SNP or a financial alignment demonstration.

View Resource:

View Resource

Search form