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Tag Archives: Dual-Eligible
Policy changes governing risk adjustment in plans for Medicare-Medicaid dual eligibles may soon be coming.
It’s hard to argue this wasn’t a decisive victory for the President and Democrats in the Senate. What remains to be seen is whether intractable Congressional Republicans will come to the table to get stuff done.
Special Needs Plans (SNPs) are a special type of health plan for America’s most vulnerable and complex seniors that are set to expire at the end of 2013. Over 500 SNPs serve more than 1.5 million Medicare beneficiaries across the United States. Done well, the SNP significantly improves outcomes and brings down costs thanks to personal care planning, care-transition assistance, disease management, and medication therapy management. Not all SNPs are good at what they’re designed to accomplish, but there are many providing patient-centered, coordinated care to vulnerable populations showing signs of success — the program should be allowed to continue.
After last week’s AHIP conference on Medicare and Medicaid and MANY coffees and cocktails later, a picture emerged that the only thing slowing the movement of dual eligibles into health plans isn’t nervous advocacy groups or overstretched regulators — it’s newbies to the game of caring for the nation’s most vulnerable patients.
CMS and at least 20 states are moving hell-bent-for-leather toward enrolling as many as 3 million of the 9 million Dual Eligibles into health plans in the next two years, creating one of the biggest opportunities for payers in history. Now a rising chorus including the Medicare Payment Advisory Commission, the American Medical Association, some policy analysts and now at least one key Senator are urging CMS to hit the brakes. I tend to think the movement of duals into plans is like the movement of water: it can be slowed but not stopped.
CMS continues to refine operational policy for Medicare Advantage and Part D plans. View our summary of the 45-Day Advance Notice and Draft Call Letter for 2013 by clicking here. I was disappointed CMS did not finalize their proposed regulations prior to issuing this document. As a result some of the more significant policy changes will be reserved for the final rate announcement and final Call Letter.