National Council for Mental Wellbeing

Skip to content National Council for Mental Wellbeing
Find a Provider
National Council for Mental Wellbeing logo
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

Michael Petruzzelli

, National Council for Behavioral Health

CMS Urges Efforts to Improve Care for Dually Eligible Population

January 3, 2019 | Medicaid | Medicare | Quality | Comments
Share on LinkedIn

Late last month, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sent a letter to state Medicaid directors describing ways states can improve care and reduce burdens for individuals who are dually-eligible for both Medicare and Medicaid. This population of individuals tends to have complex medical and behavioral health needs and accounts for a disproportionate share of federal spending for both programs. The letter outlines ten opportunities for states to improve care for the dually-eligible population in 2019.

While none of the opportunities outlined in the letter were unavailable prior to it being sent, the letter does provide a reminder to state Medicaid programs of the many different ways that care coordination can be improved. It also sends a clear signal from the Administration that CMS will devote time and effort in the new year to care for individuals who are dually-eligible.

The ten outlined opportunities for states include:

  1. State contracting with Dual eligible special needs plans (D-SNPs), a special type of Medicare Advantage plan
  2. Default enrollment into a D-SNP
  3. Passive enrollment into Medicare Advantage and Medicare Part D to preserve continuity of integrated care
  4. Integration of care through the Programs of All-Inclusive Care for the Elderly (PACE)
  5. Reducing the administrative burden in accessing Medicare data for use in care coordination
  6. Utilizing Medicare data to ensure program integrity in state Medicaid agencies
  7. Submitting reports to CMS more frequently to identify all dually eligible individuals
  8. Sharing state buy-in file data more frequently between states, the Social Security Administration and CMS
  9. Improving Medicare Part A buy-in permitting states to enroll eligible individuals at any time of the year, without late enrollment penalties
  10. Opportunities to simplify eligibility and enrollment for Part D Low-Income Subsidy benefits

For more information and details, read the CMS letter here.