Rates should be adjusted for health status of the population using a variety...
Rates should reflect functional limitations, not just diagnoses. A paper from the Massachusetts Medicaid Policy Institute Risk Adjustment for Dual Eligibles: Breaking New Ground in Massachusetts,...
View ArticleIntegrated models must ensure that the rates they pay network providers are...
This will likely mean in most cases basing provider payments on Medicare rates since experience shows that current Medicaid rates, in many cases have led to critical provider shortages. A paper by...
View ArticleNothing in the rate structure should discourage the provision of home and...
Different options can be used. In Medicaid managed care, Arizona pays plans a blended rate that incorporates nursing home and community based costs but gradually tilts to a greater percentage of...
View ArticleA Dedicated, Funded Ombudsman Program Is Essential
One risk of the dual eligible integration models is that new incentives will arise for plans and providers to deny needed care. To address this risk, enrollees should have access to an independent...
View ArticleDual Eligibles Need Robust Provider Networks
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,...
View ArticleThe Importance of Outcome Measurement
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...
View ArticleBeneficiary Protections for Enrollment
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...
View ArticleContinuity of Care Must Be Maintained
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...
View ArticleAnalysis Compares Appeals Systems in Dual Eligible Demonstration Projects
NSCLC has published an advocacy tool that compares the design of the appeals systems for the six states that currently have a Memorandum of Understanding (MOU) with the Centers for Medicare and...
View ArticleYou’ve Got Mail: Designing Enrollment Notices for a Dual Eligible...
With support from The Commonwealth Fund, NSCLC prepared a new resource, You’ve Got Mail: Designing Enrollment Notices for a Dual Eligible Demonstration Rollout. The resource is designed to assist...
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