CMS Releases New Guidance for States on How to Better Serve Medicare-Medicaid Enrollees

Regulation | December 20, 2018 | by Brendan Flinn

New CMS State Medicaid Director Letter outlines opportunities for states to make improvements in their managed care programs, use data to help inform decisions, and reduce beneficiary and provider administrative burden.

On December 19, 2018, the Centers for Medicare and Medicaid Services published a new State Medicaid Director Letter titled Ten Opportunities to Better Serve Individuals Dually Eligible for Medicaid and Medicare.

State Medicaid Director Letters are one way through which CMS communicates guidance to states on various aspects of the Medicaid program. In this particular letter, CMS spotlights ten different new and already existing ways states are able to pursue changes that could improve care for Medicare-Medicaid enrollees. Below is a list of those ten approaches. The letter provides further detail and guidance for how states can pursue each.

  1. State contracting with dual eligible special needs plans (D-SNPs)
  2. Default enrollment into a D-SNP
  3. Passive enrollment to preserve continuity of integrated care
  4. Integrating care through PACE
  5. Reducing the administrative burden in accessing Medicare data for use in care coordination
  6. Program integrity opportunities
  7. MMA file timing (named after the Medicare Prescription Drug, Improvement and Modernization Act of 2003)
  8. State buy-in file data exchange
  9. Improving Medicare Part A buy-in
  10. Opportunities to simplify eligibility and enrollment

LeadingAge will review this new guidance further and provide analysis and additional information to members.