“The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation is announcing a new opportunity to enable Medicaid Managed Care Organizations (MCOs) to better serve enrollees who are dually eligible for Medicare and Medicaid. This new Model opportunity is the first CMS initiative designed to harness the power of Medicaid MCOs to coordinate Medicare and Medicaid services and improve health outcomes for the population of dually eligible beneficiaries who are in both Medicaid managed care and Medicare fee-for-service (FFS).”
“Currently, Medicaid MCOs do not have an incentive to coordinate care in a way that reduces Medicare FFS costs for dually eligible beneficiaries. By better aligning incentives, the new opportunity for MCOs to participate in the Global and Professional Options of the Direct Contracting Model seeks to encourage Medicaid MCOs to partner with providers and suppliers and implement care coordination programs that can improve quality and reduce Medicare FFS costs.”
“’Beneficiaries eligible for both Medicare and Medicaid are some of our most vulnerable neighbors and friends, and the COVID-19 pandemic has made this abundantly clear as this population had some of the highest rates of hospitalizations for COVID-19,’ said CMS Administrator Seema Verma. ‘For too long we have struggled to deliver acceptable outcomes for this vulnerable population, but today’s model is a game changer. It represents a significant step toward addressing these longstanding issues and ensuring they receive the coordinated care they rightfully deserve.’”
“Some examples of the actions MCOs and their affiliates serving as MCO-based Direct Contracting Entities (DCEs)—organizations that participate in Direct Contracting via a participation agreement with CMS—could take to better serve dually eligible beneficiaries include:
- Establishing processes to connect aligned beneficiaries to a primary care provider, particularly high-value Medicare fee-for-service healthcare providers;
- Risk-stratifying and targeting care coordination resources toward aligned beneficiaries at risk of high Medicare spending;
- Deploying care coordinators or in-home aides who provide Medicaid long term services and supports to also actively promote flu vaccines, preventive screenings, evidence-based falls prevention, and diabetes management activities;
- Having care coordinators or in-home aides who provide Medicaid long term services and supports assist enrollees with managing Medicare-covered medical appointments to help reduce missed treatments;
- Training in-home aides – who often cook meals for their clients – on meal preparation for individuals with nutrition-sensitive conditions, like diabetes; and
- Entering into value-based purchasing arrangements with nursing facilities that factor in facilities’ hospitalization rates…” Read the full press release here.
Source: CMS Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid – December 17, 2020. CMS.
