Dual Demonstration Sample Clauses

Dual Demonstration. ‌ 3.21.2.1 The MCO agrees to participate in the CMS Demonstration to Align Administrative Functions for Improvements in Beneficiary Experience (Demonstration) as a Fully Integrated Medicare Advantage Dual Eligible Special Needs Plan (FIDE SNP, as defined in 42 CFR §§422.2 and 422.107(c)) for MSHO enrollees as outlined in the Memorandum of Understanding between CMS and the STATE. The demonstration’s goals will be to improve the integration of Medicare and Medicaid through increased participation of integrated provider health care delivery systems with exclusively aligned enrollment, improve enrollee health outcomes as measured through risk adjusted quality metrics appropriate to the enrolled population, and to align administrative systems including beneficiary communication materials, enrollment, communications, grievances and appeals processes, and quality improvement, to improve efficiency and beneficiary experience. [42 CFR §§422.2, 422.107] (1) The STATE will include the MCO in calls between CMS and the STATE to work out details of any provisions of the demonstration affecting the MCO’s Medicare SNP and Medicaid operations, provider networks, provider contracting and policies. (2) The STATE will establish a workgroup for consultation with the MCOs on work plan development and implementation of the demonstration. Topics shall include: (a) CMS-STATE Contract Management Team, section IV (G) of the MOU; (b) CMS-STATE Network Adequacy Review Process, section III (a) of the MOU; (c) MCO’s SNP Contract Amendment as proposed by CMS; (d) Integration of the CAHPS survey to streamline administration, and (e) Streamlining of quality assurance reporting and testing of potential quality measures; and (f) Other MOU items as necessary.

Dual Demonstration. The MCO agrees to participate in the CMS Dual Eligible Demonstration as a Fully Integrated Medicare Advantage Dual Eligible Special Needs Plan (FIDE SNP, as defined in 42 CFR § 422.2 and further defined by CMS in the 2014 SNP Application) for MSHO enrollees as outlined in the Memorandum of Understanding between CMS and the STATE. The demonstration’s goals will be to improve the integration of Medicare and Medicaid through increased participation of integrated provider health care delivery systems, improve enrollee health outcomes as measured through risk adjusted quality metrics appropriate to the enrolled population, and to align administrative systems to improve efficiency and beneficiary experience. (1) The STATE will include the MCO in regular calls between CMS and the STATE to work out details of any provisions of the demonstration affecting the MCO’s Medicare SNP and Medicaid operations, provider networks, provider contracting and policies. (2) The STATE will establish a work group for consultation with the MCOs on planning and implementation for the demonstration including development of ICSP quality metrics, and development of any Request for Information (RFI) and proposal and reporting templates for ICSP models. The initial outline of the model was published as the Minnesota Demonstration Proposal dated April 26, 2012 (see xxxx://xxx.xxx.xxx/Medicare-Medicaid-Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- Office/Downloads/MinnesotaProposal.pdf ).