Dual eligibles often have long-standing relationships with primary care, specialty and durable medical equipment providers; many are stabilized on complex treatment or drug regimes. Even brief disruptions can have a serious impact on the health of this medically vulnerable population. … Continue reading
Category Archives: consumer protections
The Medicare-Medicaid Coordination Office has issued guidance inviting states to issue proposals for integrating Medicare and Medicaid services. Some of these proposals intend to use passive enrollment (also known as “opt-out”) processes. Passive enrollment auto-enrolls individuals into a new health … Continue reading
On March 27, 2012 at a California Senate information hearing on In Home Supportive Services Integration into Medi-Cal Managed Care, Stephen Kaye presented a paper on the outcome measurements for managed LTSS. Read Managed Long-Term Services and Supports in California: … Continue reading
When building new models for serving dual eligibles, it is essential that those models provide adequate access to providers that are able to serve the unique needs of dual eligibles. In particular, measures of network adequacy need to take into … Continue reading
The Medicare-Medicaid Coordination Office and many of the 15 contracted states are proposing to integrate models and services in ways and at a level that have not been tried before. Care must be taken to ensure that working delivery systems … Continue reading
Structures must be in place to ensure that integrated models are performing contracted duties and delivering high quality services. Oversight and monitoring should be a coordinated and complementary effort by state Medicaid agencies, CMS, an independent advocate for enrollees, and … Continue reading
The Massachusetts demonstration proposal includes a requirement that an independent expert participate in the care planning process for beneficiaries needing LTSS. After noting that nearly 31 percent of Massachusetts’ dual-eligible population uses LTSS, the Proposal requires that each care team have … Continue reading
An integrated model must ensure that enrollees have access to all Medicare and all Medicaid covered services. In addition, the model should deliver “enhanced” benefits, especially those designed to keep individuals living at home and in the community. Provision of … Continue reading
Dual eligibles interacting with integration models must retain their right to choose how, where and from whom they receive care. The principle of choice begins with a truly voluntary, “opt in” enrollment model, but also includes the right to: Choose all … Continue reading