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States, in partnership with the federal government, must have sufficient capacity to monitor MCO compliance effectively and take corrective action where necessary.
Federal and state governments must ensure that all models of care designed to enhance beneficiary experience, improve quality, reduce unnecessary service use, and lower costs for duals (including f
Federal and state governments should ensure the care that dual-eligibles receive through MCOs and other delivery models is coordinated and delivered in a person- and family-centered manner.
States should ensure that all care and services provided to dual-eligibles through MCOs address their individual health care and LTSS needs and preferences (including a self-directed care option fo
Both levels of government should ensure that efforts to harmonize Medicare and Medicaid preserve beneficiary access to each program’s most protective benefit and due process policies.
Federal and state governments should collaborate to develop, execute, and continually evaluate a coordinated Medicare-Medicaid grievance and appeals process for dual-eligibles.