Oversight and Monitoring

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).

D-SNP Performance Monitoring and Oversight: State Experiences and CMS Resources


This webinar covers resources and strategies available to states to begin or improve their oversight of Dual Eligible Special Needs Plans (D-SNPs). Presenters provide an overview of the Centers for Medicare & Medicaid Services’ (CMS) publicly available D-SNP performance monitoring resources and share approaches used by Oregon and Tennessee to incorporate performance monitoring and oversight requirements into D-SNP contracts.

How States Can Use Medicare Advantage Star Ratings to Assess D-SNP Quality and Performance

The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to evaluate the performance of Medicare Advantage (MA) health plans. This Star Rating system enables beneficiaries, payers, and others to compare plans across multiple dimensions. CMS publishes the Star Ratings each year – usually in October -- to help beneficiaries find the best plan for them and to determine MA quality bonus payments to plans. The lowest-ranking plans receive one star, and the highest ranking plans receive five stars. The 2021 Star Ratings are now available on CMS’ website. 

State Perspectives on Contracting with Dual Eligible Special Needs Plan


This presentation highlights the ICRC technical assistance tool State Contracting with Medicare Advantage Dual Eligible Special Needs Plans: Issues and Options and features a moderated panel discussion among representatives of three states (Minnesota, New Jersey, and Tennessee) with a wide range of experience in contracting with D-SNPs.

Medicare Advantage D-SNP Contract Oversight and Quality Monitoring


This webinar summarizes a discussion among states, the Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors, and ICRC about Medicare Advantage Dual Eligible Special Needs Plan contract oversight and quality monitoring procedures.