Enrollment

Medicare-Medicaid Plan (MMP) Enrollment Processing Updates Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

Study Hall Call
8/26/2020

On August 26, 2020 from 1:00-2:30 pm ET  the Integrated Care Resource Center (ICRC) hosted a Study Hall Call on Medicare-Medicaid Plan (MMP) Enrollment Processing Updates Resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

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:

Medicare Enrollment Periods and Special Election Periods for Dually Eligible Individuals: Reference Tables

This technical assistance tool provides tables describing both general and special election periods relevant to the enrollment of dually eligible indiviuals in drug management programs into Medicare Advantage plans, including Medicare--Medicaid Plans operating in demonstrations under the Financial Alignment Initiative.

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

Study Hall Call
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

Technical Guide for Medicare-Medicaid Plan Enrollment v 3.0

The Centers for Medicare & Medicaid Services (CMS) has released an updated version (3.0) of Medicare and Medicaid Plans: A Technical Guide to Eligibility and Enrollment Transaction Processing. Version 3.0 of the technical guide continues to address the CMS Fall 2018 Software changes as documented in the final HPMS notice dated October 4, 2018. A new date field (Beneficiary’s Last use of Dual/LIS Special Election Period (SEP – Election type “L”) has been added to the MBD Eligibility Response layout. The revision history section of the document details this change.

The Complex Art of Making It Simple: Factors Affecting Enrollment in Integrated Care Demonstrations for Dually Eligible Beneficiaries

Dually eligible beneficiaries began enrolling in integrated Medicare-Medicaid plans (MMPs) under the Financial Alignment Initiative (FAI) in calendar year 2013. Under the FAI, the Centers for Medicare & Medicaid Services (CMS) and 10 participating states contracted with MMPs under capitated arrangements to coordinate Medicare and Medicaid benefits. Beneficiary participation has been lower than anticipated. Only about 29 percent of eligible individuals enrolled in MMPs in 2017.

State and MMP User Guides for MMP Enrollment Processing

Medicare-Medicaid Plan (MMP) Technical Guide to Eligibility and Enrollment Transaction Processing

This guide describes the interface that states with Financial Alignment Initiative Demonstrations use to conduct Medicare eligibility verification and MMP enrollment submission to the CMS MARx systems. Version 3.3 of the Guide reflects the CMS October 2020 software changes as documented in the HPMS Software release announcements on August 25, 2020 and September 1, 2020.

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