Spotlight E-alert

CMS Updates Processes for D-SNPs Implementing CY 2021 Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements in Response to COVID-19: Clarification on Direct Contracts with States

Centers for Medicare & Medicaid Services (CMS) issued a memo detailing important updates on CMS processes for review and approval of state Medicaid agency contracts (SMACs) for contract year 2021. These updates acknowledge the unique circumstances resulting from Dual Eligible Special Needs Plans’ (D-SNPs’) and states’ priority focus on the COVID-19 public health emergency.

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 will 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).

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:

CMS Releases Final Rule on D-SNP Integration and Integrated Appeals

On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) published new final rule for Medicare Advantage and Part D that implements provisions of the Bipartisan Budget Act of 2018 related to the integration of Medicare and Medicaid services and unification of Medicare and Medicaid grievance and appeals procedures by Dual Eligible Special Needs Plans (D-SNPs).

CMS' Medicare Advantage and Part D Rates and Guidance for Calendar Year 2020

On April 1, 2019, the Centers for Medicare & Medicaid Services (CMS) published the Final Call Letter and Rate Announcement outlining guidance for the 2020 plan year for Medicare Advantage (MA) plans, including Dual Eligible Special Needs Plans (D-SNPs) and Medicare-Medicaid Plans (MMPs) under the Financial Alignment Initiative.

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