Home Health & Hospice Week

Stand by for potential changes to how you are reimbursed for your patients who are dually eligible for both Medicare and Medicaid.

The Centers for Medicare & Medicaid Services has “sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid,” the agency says in a release. “Many of the 12 million dually eligible beneficiaries have complex healthcare issues, including multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes,” CMS says.

“Less than 10 percent of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems. This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative ineffi­ciencies and programmatic burdens for all,” CMS Administrator Seema Verma says in the release. “We must do better, and CMS is taking action.”

CMS offers capitated plans and “managed” fee-for-service plans as two ideas to test.