Federally qualified health center use among dual eligibles. Top ten priorities for consumer advocates background there are approximately 9 million seniors and people with disabilities enrolled in both medicaid and medicare programs dual eligibles. The massachusetts medical society appreciates the opportunity to provide comment on the masshealth section 1115 demonstration project amendment and extension request. States had to overcome challenges in identifying dual eligible beneficiaries and persuading enrollees and stakeholders of the benefits of an integrated service model. Thanks, your survey has been submitted to the mass. Open minds is a national leader in market intelligence and management best practices focused on organizations serving consumers with chronic conditions and complex needs. Premiums, copays, coinsurance, and deductibles may vary based on the level of extra help you receive.
The departmental appeals board has partnered with cms and the state of new york to adjudicate appeals stemming from the fully integrated duals advantage fida demonstration project. Civilian acquisition workforce personnel demonstration project. Apr 07, 2014 the duals demonstration project, known as cal mediconnect, is part of the states coordinated care initiative. The mmai is a groundbreaking joint effort to reform the way care is delivered to clients eligible for both medicare and medicaid services called dual eligibles. Telemedicine is viewed as a costeffective alternative to the more traditional facetoface way of providing medical care e. This map shows the current status of the state demonstration proposals to integrate care and align financing for beneficiaries eligible for both medicare and medicaid. What is a medicare advantage medicaremedicaid plan mmp. The dod, with the approval of the office of personnel management opm, received authority to conduct a personnel demonstration project within dods civilian acquisition workforce and among those supporting personnel assigned to work directly with it. Fida fullyintegrated dual advantage program for dual. Cms approves first agreement for a managed feeforservice. As part of this demonstration, cms provided support to the state to design a demonstration proposal. Fully integrated duals advantage fida demonstration project. One of the main vehicles through which the mmco has advanced this mission is the financial alignment initiative, whereby mmco partners with state medicaid programs to create demonstration projects to experiment with combining the medicare and medicaid programs into a single integrated benefit for dual eligibles.
This definition is modeled on medicares definition of telehealth services 42 cfr 410. Data on the number of plan enrollees living in nursing homes were not available during the demonstration study. Dual eligible beneficiaries are people who are enrolled in medicare and medicaid at the same time and who are eligible to receive benefits from both programs. A longstanding barrier to coordinating care for medicaremedicaid enrollees has been the financial misalignment between medicare and medicaid. Cal mediconnect plans to integrate medicare and medical services and funding for californians eligible for both programs. State demonstration to integrate care for dual eligible individuals for individuals who are ages 2164 at the time of enrollment and living with disabilities, currently serving about 20,000 members. Therefore, in 1992, the health care financing administration hcfa funded two experiments managed by two state medicaid agencies. Successful integration of managed ltc and dual demonstration.
Update on demonstrations for dualeligible medicare. Unlike a medicare advantage dual eligible special needs plan dsnp, mmps only serve full benefit dual eligible medicaremedicaid beneficiaries and. Disclaimer for dual eligible medicaremedicaid special needs plan snp. States have made significant investments in training care coordinators, providers, and medicaidmedicaid plans mmps on the special needs of dual eligibles. State demonstrations to integrate care for dual eligibles demonstration proposal oregon summary. Medicaidmedicare dual eligible updates center for medicare. Integration of managed ltc and dual demonstration plans. We applaud the transparent and inclusive process assistant secretary tsai and his office has undertaken over the past many months to ensure ample stakeholder engagement. Successful integration of managed ltc and dual demonstration plans.
Massachusetts demonstration is unique among the state proposals for its focus on full dual eligible beneficiaries ages 21 to 64 and its required independent livinglong term services and. State demonstration proposals to integrate care and align. Dualeligible beneficiaries of medicare and medicaid. The target population for the dual demonstration project will be those individuals 21 and over who are currently. In 2011, oregon was competitively selected to receive funding through cms state demonstrations to integrate care for dual eligible individuals. Premiums, copays, coinsurance, and deductibles may vary based on the level of extra help. Solutions july 29, 2014 1 national company specializing in facetoface assessment and care management services for medicare advantage ma, ma special needs plans snp, medicaid medicare plans mmp, mltc, dual demonstration. Integrated care for dual eligibles limited to four regions of. One care is an 1115a duals demonstration a financial alignment demonstration and a state demonstration to integrate care for dual eligible individuals for. Medica dual solution is a health plan that contracts with both medicare and the minnesota medical assistance medicaid program to provide benefits of both programs to enrollees. Integrating medicare and medicaid for dual eligible. While each state memorandum of understanding mou will be different, this mou with the state of washington provides some insight on what advocates may expect from cms in future managedfeeforservice dual eligible demonstration agreements. Coordinate with operations, project management and finance to help monitor and support potential and inflight projects. Eligible individuals 2011 to dateassociate project director.
The dual eligible demonstration projects, developed pursuant to the affordable care act aca, aim to improve coordination of services between medicare and medicaid. With the growth in integrated systems that include ltss for dual eligibles, there is a concern about the quality of nursing home care provided to dual eligibles by health plans. Assessing the quality of nursing homes in managed care. Demonstrations to integrate care for dual eligible individuals. The passive enrollment challenge introduction in addition to the health coverage expansions and insurance market reforms contained in the affordable care act aca, the law also launched many experiments aimed at. Integration demonstration project workplan for massachusetts. Cms demonstrations projects under the medicare modernization act mma as of may 3, 2007 among the many provisions of the medicare prescription drug, improvement, and modernization act of 2003 mma, p. Wallace led the development and implementation of the capitated financial alignment demonstration cfad for dual eligibles between the ages of.
The health plans were limited to those who participated in the dual eligible cmc demonstration project so they were not representative of health plans that did not accept dual eligibles. The states cal mediconnect project has officially started in five of the eight demonstration counties. Dual eligible beneficiaries are among the poorest and sickest beneficiaries covered by either program. The fida project will replace the parallel system of separate medicare and medicaid appeals for dually eligible beneficiaries with one single unified system in a.
Through the medicare advantage valuebased insurance design vbid model, cms is testing a broad array of complementary medicare advantage ma health plan innovations designed to reduce medicare program expenditures, enhance the quality of care for medicare beneficiaries, including those with low incomes such as dual eligibles, and improve the coordination and efficiency of health care. State demonstrations to integrate care for dual eligibles. Medicare diabetes prevention program mdpp expanded model. Under the demonstration, medicaremedicaid plans mmps, provide both medicaid and medicare benefits to demonstration enrollees. Several other important demonstrations and initiatives intended to improve care are also in the midst of implementation, including accountable care organizations and health homes. A medicare advantage medicaremedicaid plan mmp is a private health plan designed to provide integrated and coordinated medicare and medicaid benefits for dual eligible medicare beneficiaries. Software professional development program spdp course information our faculty provides dod software acquisition and development processes and af software best practices through distance learning and tailored workshops covering. For purposes of medicaid, telemedicine seeks to improve a patients health by permitting twoway, real time interactive communication between the patient, and the physician or practitioner at the distant site. Massachusetts integrated demonstration project workplan page 1 of 33.
The number of dual eligibles receiving care at a health center increased from 446,329 in 2008 to 542,777 in 2010. These comprehensive health plans provide all the services covered. Recipients enrolled in minnesota health care programs and eligible for medicare or other third party insurance benefit. Duals demonstration project begins california healthline. Colorado dual eligible demonstration primary care collaborative. State dual eligible demonstration projects key consumer issues 2 c. Massachusetts integration demonstration project pilot is based on three goals which drive the workplan leading to the implementation of a sound.
The clinical intervention consists of a minimum of 16 intensive core sessions of a centers for disease control and prevention cdc approved curriculum furnished. Health officials hope to move as many as 456,000 dual. Massachusetts medical homes the national academy for. Randall klein, president, complexcare solutions july 29, 2014 1 national company specializing in facetoface assessment and care. Cms dual eligible demonstration primary care collaborative. The state demonstration to integrate care for medicaremedicaid enrollees will integrate and coordinate physical, behavioral and social health needs for medicaremedicaid clients. Download july 2012 dual eligible demonstration faqs pdf the following faqs are subject to change based on regulatory changes, requirements, and additional guidance from the department of health care services dhcs and the centers for medicare and medicaid services cms. The goal of these demonstrations is to develop personcentered care delivery models, integrating the full range of medical, behavioral health, and longterm care services for dual eligible individuals with the expectation that integrated delivery. This website is designed as a resource for advocates, providing resources, background information, and updates to help consumer advocates work with states to ensure new models improve care for dual eligibles. Mi health link is a demonstration for dual eligible individuals under the cms financial alignment initiative. The health plans were limited to those who participated in the dualeligible cmc demonstration project so they were not representative of health plans that did not accept dual eligibles. Characteristics of full dual eligible beneficiaries, 2009 source. State spending on dual eligibles under age 65 shows. Innovation fellow intern in boston, massachusetts careers.
Fai consumer assessment of healthcare providers and systems cahps survey results 122017 pdf. American indians can continue to use tribal and indian health services ihs clinics. Jul 10, 2015 the departmental appeals board has partnered with cms and the state of new york to adjudicate appeals stemming from the fully integrated duals advantage fida demonstration project. The fida project will replace the parallel system of separate medicare and medicaid appeals for duallyeligible beneficiaries with one single unified system in a. Massachusetts demonstration to integrate care and align. The initiative builds on the infrastructure, resources and provider network found in the accountable care collaborative acc program, which connects clients with. Like a number of other states, michigan plans to implement an integrated care for dual eligibles demonstration project beginning next year. Enrollment in medica dual solution depends on contract renewal. This plan is available to anyone who has both medical assistance from the state and medicare. This three year initiative, an outgrowth of the patient protection and affordable care act, is designed to integrate all medicaid and medicare covered services including acute and primary care, behavioral health, and long term services and supports for.
June 20 dual eligible beneficiaries of medicare and medicaid 3 cbo figure 1. These consumers represent some of the most vulnerable populations in. Sep 15, 2018 with the growth in integrated systems that include ltss for dual eligibles, there is a concern about the quality of nursing home care provided to dual eligibles by health plans. Medicare advantage valuebased insurance design model. First, we stay exclusively focused on a very specific set of domains in the health and human service field mental health, addiction treatment, chronic disease management. This final rule will revise the medicare advantage ma program part c regulations and prescription drug benefit program part d regulations to implement certain provisions of the comprehensive addiction and recovery act cara to further reduce the number of.
Learning and adjusting nov 15, 2015 health policy hub leena sharma in july, the ocean state became the thirteenth state to sign a memorandum of understanding mou with the centers for medicare and medicaid services cms to move forward with integrating services and financing for its. The financial alignment initiative has two models, the capitated model and managed feeforservice model. As states implement these new models, advocates for dual eligibles must be involved. A dual eligible demonstration program is also called an integrated care delivery system icds, which is a system of managed care plans selected to coordinate physical, behavioral, and longterm care services for individuals over the age of 18 who are eligible for both medicaid and medicare. If you would like to continue helping us improve mass. Senior care options hmo snp, for individuals ages 65 and over who have medicare and masshealth standard or only masshealth standard. Voluntary enrollment will begin march 1, 2015 in regions 1 and 4 and on may 1, 2015 in regions 7 and 9. What is a demonstrationpilot program in medicare part d. Masshealth members may be able to get doctors visits, prescription drugs, hospital stays, and many other important services. The passive enrollment challenge introduction in addition to the health coverage expansions and insurance market reforms contained in the affordable care act aca, the law also launched many experiments aimed at changing the delivery and financing of health care. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment. The mmai demonstration project began providing coordinated care to medicaremedicaid enrollees in the chicagoland area and central illinois beginning march 2014. The medicare diabetes prevention program expanded model is a structured intervention with the goal of preventing type 2 diabetes in individuals with an indication of prediabetes.
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