CMS creates direct contracting model to serve individuals dually eligible for Medicare and Medicaid

The Heart for Medicare and Medicaid Innovation has established a new immediate contracting design to…

The Heart for Medicare and Medicaid Innovation has established a new immediate contracting design to enable Medicaid Managed Treatment Companies to improved serve enrollees who are dually eligible for Medicare and Medicaid.

The innovation center established a new type of immediate contracting entity that lets Medicaid MCOs to participate in the global and skilled selections of the immediate contracting design.

At the moment, Medicaid MCOs have no incentive to coordinate care for their dually eligible beneficiaries in a way that reduces Medicare fee-for-support fees, CMS stated in its announcement.

The new chance will exam how money possibility-sharing preparations can cut down Medicare expenses even though preserving or enhancing the top quality of care for beneficiaries. It will also build the previously missing incentives and flexibilities for Medicaid MCOs to improved coordinate care for dually eligible beneficiaries.

To participate in the immediate contracting design, MCO-based immediate contracting entities should get hold of a letter of support from their state Medicaid agency. CMS stated it would supply further information about the information of this letter in the near upcoming.

In early 2021, CMS will release a request for purposes for all skilled and global immediate contracting entities and Medicaid MCOs will start out collaborating in the design in January 2022.

WHY THIS Matters

CMS believes that developing this incentive chance will aid dually eligible people today get access to a total scope of care, together with main, acute, prolonged-expression, behavioral and social care.

Medicaid MCOs collaborating in the new immediate contracting chance will be in a position to consider actions to improved serve their dually eligible people today these kinds of as: connecting beneficiaries to a main care service provider, targeting coordinated care sources at beneficiaries at possibility of large Medicare expending, training and deploying in-property aides who can supply Medicaid providers, and creating value-based obtaining agreements with nursing facilities.

THE Greater Development

Last 12 months, more than 12 million Individuals had been enrolled in both of those Medicare and Medicaid, in accordance to CMS. This inhabitants is in particular at possibility, with 70% of dually eligible people today obtaining three or more chronic ailments and more than 40% obtaining at the very least a single mental health and fitness diagnosis.

In November, the innovation center announced that 51 service provider and accountable care corporations are collaborating in immediate contracting in the upcoming 12 months. The 51 immediate contracting entities serve beneficiaries in 39 states as nicely as in the District of Columbia and Puerto Rico.

ON THE Report

“Beneficiaries eligible for both of those Medicare and Medicaid are some of our most susceptible neighbors and close friends, and the COVID-19 pandemic has manufactured this abundantly apparent as this inhabitants experienced some of the highest rates of hospitalizations for COVID-19,” stated CMS Administrator Seema Verma.

“For also prolonged we have struggled to supply suitable results for this susceptible inhabitants, but modern design is a video game-changer. It represents a important action toward addressing these longstanding difficulties and making sure they receive the coordinated care they rightfully should have.”

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