Dual Eligibles

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June 2022 Report to Congress on Medicaid and CHIP

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP. The report recommends measures that Congress can take to better monitor access to care for Medicaid beneficiaries, improve the oversight and transparency of managed care directed payments, increase access to vaccines for adults enrolled in Medicaid, encourage the uptake of health information technology in behavioral health, and better integrate care for Medicaid and Medicare dual-eligibles. The commission also offers policy levers that states and the federal government can use to promote equity in Medicaid.

Short URL: http://www.advancingstates.org/node/73981

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Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules

CMS has released a new proposed rule with several provisions related to dual eligible individuals and would impact states. The proposed rule includes provisions to: Limit retroactive Medicare Part B premium liability for states to 36 months, Retire the old stand-alone buy-in agreements and specify that the provisions of a state buy-in agreement shall be set forth in the state’s Medicaid state plan, Extend the Medicare Savings Programs (MSPs) to cover premiums and cost sharing for individuals enrolling in the new Medicare immunosuppressive drug benefit. CMS is currently requesting comments on the proposed rule.

Short URL: http://www.advancingstates.org/node/73876

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2022 Beneficiaries Dually Eligible for Medicare and Medicaid Data Book

The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) have released an updated data book, Beneficiaries Dually Eligible for Medicare and Medicaid. This is the sixth edition of the book and describes the dually eligible population’s composition, service use, and spending in 2019. The book compares subgroups of dually eligible beneficiaries, such as those with full and partial benefits as well as those under age 65 and those ages 65 and older.

Short URL: http://www.advancingstates.org/node/73566

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Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15, 2022.

Short URL: http://www.advancingstates.org/node/73327

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Integrated Care for People with Medicare and Medicaid

NCOA, in partnership with the Medicare Rights Center, recently expanded the resources in their toolkit that help explain integrated care coverage options for dual eligibles. New items in the toolkit include a video tutorial explaining integrated care, an infographic for counselors, and comparison charts highlighting the differences between Original Medicare, PACE, Duals Special Needs Plans (D-SNPs) and integrated D-SNPs.

Short URL: http://www.advancingstates.org/node/73204

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State Health Official Letter - Updated Guidance Related to Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency

CMS released a SHO letter with updated guidance to assist states in planning for resuming normal state Medicaid, CHIP, and BHP operations for the eventual end of the public health emergency. The SHO provides updated guidance regarding the extended timeframe for states to complete pending work in eligibility and enrollment to up to 12 months after the PHE ends and redetermination of eligibility requirements states must complete after the PHE for all beneficiaries before taking adverse actions.

Short URL: http://www.advancingstates.org/node/72973

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State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans

This publication from Health Management Associates analyzes the approaches that Medicaid programs in DC, Idaho, Maine, Washington and Alabama used to coordinate Medicare and Medicaid services without standalone Medicaid MLTSS programs. The paper focuses on Medicaid and Aging agencies overseeing programs that provide long-term services and supports fee for service and explores effective methods to coordinate and integrate care with Medicare Advantage Dual Eligible Special Needs Plans.

Short URL: http://www.advancingstates.org/node/72773

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Multimodal Pain Management: Considerations for Clinicians Treating Pain

Dual eligibles for Medicare and Medicaid have higher levels of chronic pain and use prescription opioids to treat pain more often than those eligible for Medicare only, putting them at a higher risk for opioid misuse or addiction. This brief presents examples of multimodal pain management options that clinicians can consider for treating pain among dually eligible individuals. The resource describes various treatment options, key evidence, and prescribing considerations for each option.

Short URL: http://www.advancingstates.org/node/72631

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