By The Heart for Medicare and Medicaid Innovation has created a brand new direct contracting mannequin to allow Medicaid Managed Care Organizations to higher serve enrollees who’re dually eligible for Medicare and Medicaid.
The innovation middle created a brand new kind of direct contracting entity that enables Medicaid MCOs to take part within the world {and professional} choices of the direct contracting mannequin.
At the moment, Medicaid MCOs haven’t any incentive to coordinate care for his or her dually eligible beneficiaries in a manner that reduces Medicare fee-for-service prices, CMS stated in its announcement.
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The brand new alternative will take a look at how monetary risk-sharing preparations can scale back Medicare expenditures whereas preserving or enhancing the standard of take care of beneficiaries. It would additionally create the beforehand missing incentives and flexibilities for Medicaid MCOs to higher coordinate take care of dually eligible beneficiaries.
To take part within the direct contracting mannequin, MCO-based direct contracting entities should acquire a letter of help from their state Medicaid company. CMS stated it could present further details about the content material of this letter within the close to future.
In early 2021, CMS will launch a request for purposes for all skilled and world direct contracting entities and Medicaid MCOs will start taking part within the mannequin in January 2022.
WHY THIS MATTERS
CMS believes that creating this incentive alternative will assist dually eligible people get entry to a full scope of care, together with main, acute, long-term, behavioral and social care.
Medicaid MCOs taking part within the new direct contracting alternative will be capable to take actions to higher serve their dually eligible people corresponding to: connecting beneficiaries to a main care supplier, concentrating on coordinated care assets at beneficiaries prone to excessive Medicare spending, coaching and deploying in-home aides who can present Medicaid companies, and creating value-based buying agreements with nursing services.
THE LARGER TREND
Final 12 months, greater than 12 million People had been enrolled in each Medicare and Medicaid, in response to CMS. This inhabitants is particularly in danger, with 70% of dually eligible people having three or extra continual situations and greater than 40% having no less than one psychological well being prognosis.
In November, the innovation middle introduced that 51 supplier and accountable care organizations are taking part in direct contracting within the upcoming 12 months. The 51 direct contracting entities serve beneficiaries in 39 states in addition to within the District of Columbia and Puerto Rico.
ON THE RECORD
“Beneficiaries eligible for each Medicare and Medicaid are a few of our most weak neighbors and buddies, and the COVID-19 pandemic has made this abundantly clear as this inhabitants had among the highest charges of hospitalizations for COVID-19,” stated CMS Administrator Seema Verma.
“For too lengthy now we have struggled to ship acceptable outcomes for this weak inhabitants, however right this moment’s mannequin is a game-changer. It represents a big step towards addressing these longstanding points and guaranteeing they obtain the coordinated care they rightfully deserve.”
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