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