CMS Creates Direct Contracting Model to Serve Individuals Dually Eligible for Medicare and Medicaid

The Center for Medicare and Medicaid Innovation has created a new direct contracting model to enable Medicaid Managed Care Organizations to better serve enrollees who are dually eligible for Medicare and Medicaid.

The innovation center created a new type of direct contracting entity that allows Medicaid MCOs to participate in the global and professional options of the direct contracting model.

The new opportunity will test how financial risk-sharing arrangements can reduce Medicare expenditures while preserving or enhancing the quality of care for beneficiaries. It will also create the previously lacking incentives and flexibilities for Medicaid MCOs to better coordinate care for dually eligible beneficiaries.

To participate in the direct contracting model, MCO-based direct contracting entities must obtain a letter of support from their state Medicaid agency. CMS said it would provide additional information about the content of this letter in the near future.

CMS believes that creating this incentive opportunity will help dually eligible individuals get access to a full scope of care, including primary, acute, long-term, behavioral and social care.

Medicaid MCOs participating in the new direct contracting opportunity will be able to take actions to better serve their dually eligible individuals such as: connecting beneficiaries to a primary care provider, targeting coordinated care resources at beneficiaries at risk of high Medicare spending, training and deploying in-home aides who can provide Medicaid services, and creating value-based purchasing agreements with nursing facilities.

Source: https://www.healthcarefinancenews.com/news/cms-creates-direct-contracting-model-serve-individuals-dually-eligible-medicare-and-medicaid