Title

Financial Alignment Initiative: New York Integrated Appeals and Grievances Demonstration. First Brief Report

Document Type

Report

Publication Date

3-2022

Keywords

financial alignment, Medicaid, Medicare, CMS, New York, policies, dually eligible

Abstract

Beneficiaries who are dually eligible for Medicare-Medicaid and who are enrolled in managed care plans must navigate two different systems if they appeal their plan’s reduction, termination, or denial of service. Medicare and Medicaid have different policies and procedures and navigating these two systems is administratively complex and challenging for beneficiaries. The Centers for Medicare & Medicaid Services (CMS)-New York Integrated Appeals and Grievances demonstration is designed to integrate and streamline these processes. CMS contracted with RTI International to conduct an independent evaluation of the New York Integrated Appeals and Grievances demonstration to determine its impact on beneficiary and plan experience. This first brief report covers the first demonstration year, January 1, 2020 through December 31, 2020. It includes findings from interviews conducted in spring 2021 with beneficiary advocates, plans, CMS, and New York State officials. We also include an analysis of Medicare cost savings generated by the NY Integrated A&G demonstration that was conducted by the CMS Medicare/Medicaid Coordination Office (MMCO).

Comments

This project was funded by the Centers for Medicare & Medicaid Services under contract no. HHSM-500-2014-00037i TO #7. The statements contained in this report are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. RTI assumes responsibility for the accuracy and completeness of the information contained in this report.

Funding Organization

Centers for Medicare & Medicaid Services

Grant Number

Contract No. HHSM-500-2014-00037i TO #7

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