« The Dual Agenda: March 19, 2015 Issue
Noteworthy News
Medicare-Medicaid Coordination Office Submits Report to Congress
On March 17, the Medicare-Medicaid Coordination Office (MMCO) submitted its fiscal year 2014 report to Congress. The report provides an update on the MMCO’s efforts to better serve dual eligibles, reduce misalignments, improve quality and lower costs. It also outlines a series of policy recommendations, including:
- Creating a Pilot to Expand Programs of All-Inclusive Care for the Elderly (PACE) Eligibility to Individuals between Ages 21 and 55
- Ensuring Retroactive Part D Coverage of Newly-Eligible Low Income Beneficiaries
- Establishing Integrated Appeals Process for Medicare-Medicaid Enrollees
- Allowing for Federal/State Coordinated Review of Duals Special Need Plan Marketing Materials
In addition, the report includes information about three policy areas CMS is examining that may have the potential to improve the experience of Medicare-Medicaid enrollees. These include:
- Coverage Standards for Overlapping Medicare and Medicaid Benefits
- Cost-Sharing Rules for Qualified Medicare Beneficiaries
- Quality Measures and Medicare-Medicaid Enrollees
Wisconsin Governor Proposes Surprise Overhaul of Long-Term Care
In early March, the Milwaukee Journal Sentinel reported that Wisconsin Governor Scott Walker included in his proposed budget a massive overhaul of the system that provides long-term care to over 50,000 elderly and disabled people across the state. The proposal would affect more than $2 billion in spending and replace a decades-old system with a new model in which the state would contract with insurance companies to provide both long-term and medical care. The proposal would require insurance companies or other organizations participating in the program to operate statewide, thereby giving large insurers a distinct advantage. Of particular concern to advocates was the surprise nature of the sweeping proposal, which had not been discussed with advocates, existing providers or, it appears, even the Governor’s own Secretary of the Department of Human Services.
Early Adopters of Medicaid ACOs Beginning to Show Encouraging Results
A Commonwealth Fund blog post by Tricia McGinnis summarizes preliminary findings from three early adopters of Medicaid Accountable Care Organization (ACO) projects. Colorado’s Regional Care Collaborative Organizations, Oregon’s Coordinated Care Organizations and Minnesota’s Integrated Health Partnerships all show at least some evidence of improving care and lowering cost, though no program demonstrated positive results in all areas. With support from The Commonwealth Fund, the Center for Health Care Strategies is launching a learning collaborative with these three and other early adopter states to foster cross-state learning and accelerate the pace of identifying and adopting best practices.
Applications for New ACO Model Released by CMS
The Centers for Medicare and Medicaid Services (CMS) has released materials about how to apply for participation in the Next Generation ACO Model. This is an initiative for ACOs that are already experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program. The goal of the new model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Medicare beneficiaries. CMS expects 15-20 ACOs to participate in the new model, with round one Letters of Intent due on May 1.