Financial Alignment Initiative: New York Integrated Appeals and Grievances Demonstration. First Brief Report
financial alignment, Medicaid, Medicare, CMS, New York, policies, dually eligible
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).
Centers for Medicare & Medicaid Services
Contract No. HHSM-500-2014-00037i TO #7
Snow, K. I., Gattine, E. C., Walsh, E. G., & Chepaitis, A. E. (2022, March). Financial Alignment Initiative New York Integrated Appeals and Grievances Demonstration. First Brief Report. RTI International. Retrieved from: https://innovation.cms.gov/data-and-reports/2022/fai-ny-first-combined-rpt