Stakeholders Ask CMS To Halt Pilot Program for Dual-Eligible Enrollees
Stakeholders are calling on CMS to halt implementation of a demonstration program that is intended to reduce costs and improve care for beneficiaries eligible for both Medicaid and Medicare, Politico reports.
The program -- established by the Federal Coordinated Health Care Office, which was created under the federal health reform law -- aims to better coordinate care for the nine million U.S. residents eligible for both programs by placing them in either a capitated or a managed fee-for-service plan, or both.
However, higher-than-anticipated enrollment has caused some health care provider and advocacy groups -- including the Medicare Payment Advisory Commission and the American Medical Association -- to raise concerns about the program's design.
The groups warn that the patient influx has effectively turned the pilot program into a waiver, which would be hard to undo if the demonstration fails.
Other concerns relate to:
- Moving dual eligibles from one provider to the next;
- Whether managed care plans are able to handle the new beneficiaries; and
- Whether the pilot can produce savings while improving care quality.
Hospitals also have raised concerns about the program's financial impact and how participating providers will be reimbursed.
Sen. Jay Rockefeller (D-W.Va.) -- who helped create the office leading the pilot -- also has called for a delay. In a letter sent last week to HHS Secretary Kathleen Sebelius, Rockefeller said the design was too focused on savings rather than improving care. "[T]he financial alignment initiative also seems to be in direct conflict with the eight, very specific, statutory goals Congress outlined for the office," he wrote, adding, "None of which mention savings."
CMS spokesperson Brian Cook in an email wrote, "Given the diversity and significant health care needs of dual eligibles, we recognize how critical it is to have beneficiary protections in place to achieve the highest-quality health care possible."
He added, "We are taking the input from Congress, MedPAC and others very seriously moving forward" (DoBias, Politico, 7/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.