Medicare Resources

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

CMS Releases Additional Guidance on D-SNP Integration Requirements

On January 17, 2020, the Centers for Medicare & Medicaid Services (CMS) issued additional guidance and clarification on four topics related to CY2021 requirements for Dual Eligible Special Needs Plans (D-SNPs). The guidance follows on an October 2019 an HPMS memo summarizing the new D-SNP requirements and providing guidance on contract and operational changes needed for CY2021.

CMS Issues Memo to Medicare Advantage Plans to Encourage Continuity of Care for Dually Eligible Enrollees Currently Receiving Opioid Treatment Program Services through Medicaid

On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing a new opioid treatment program (OTP) benefit under Medicare Part B, starting January 1, 2020. 

OTP Part B Deductible Informational Bulletin and Tip Sheet

Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin to provide guidance to states regarding coverage changes for dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) receiving opioid treatment services, as well as a Tip Sheet for Opioid Treatment Program (OTP) Providers Serving Dually Eligible Individuals: State Coverage of the Medicare Part B Deductible.

Spotlight: Final CMS Changes to Medicare Physician Payment and Opioid Use Disorder Benefits for Calendar Year 2020 Could Have Implications for State Medicaid Programs

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates policies for services furnished under the Medicare Physician Fee Schedule and for Opioid Use Disorder (OUD) services in calendar year (CY) 2020 and thereafter.

The changes may have implications for states that:

New CMS Memo Summarizes Medicare-Medicaid Integration and State Contract Requirements for D-SNPs

This Spotlight highlights key takeaways from the CMS October  memo related to: (1) integration requirements that apply to all D-SNPs and the states in which they operate; and (2) requirements for unified appeals and grievances that apply to some D-SNPs and affiliated Medicaid managed care plans in states that limit D-SNP enrollment only to those individuals who receive their Medicaid benefits from an affiliated Medicaid plan. It also includes a table that highlights key features and differences between FIDE SNPs and HIDE SNPs

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