MM Curator summary
A new CMS direct contracting model will allow Medicaid health plans to provide more services in the homes of members.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
The Centers for Medicare & Medicaid Services’ new model for 2021 enables Medicaid managed care organizations (MCOs) to allow in-home aides to promote flu vaccines, manage medical appointments, and receive training on meal preparation for clients with diabetes and other nutrition-sensitive conditions. As part of the model, beneficiaries must be concurrently enrolled in both Medicaid managed care and Medicare fee-for-service (FFS) programs.
The model, which CMS unveiled recently, strives to encourage Medicaid MCOs to partner with providers and suppliers, and implement care coordination programs that can improve quality and reduce Medicare FFS costs for dually eligible beneficiaries — or those who receive Medicare and Medicaid.
“Beneficiaries eligible for both Medicare and Medicaid are some of our most vulnerable neighbors and friends, and the COVID-19 pandemic has made this abundantly clear,” CMS Administrator Seema Verma recently said. “For too long we have struggled to deliver acceptable outcomes for this population, but today’s model is a game changer. It represents a significant step toward addressing these longstanding issues.”
Some examples of the actions MCOs and their affiliates serving as MCO-based Direct Contracting Entities (DCEs) — organizations that participate in Direct Contracting via a participation agreement with CMS — could take to better serve dually eligible beneficiaries include:
· Deploying care coordinators or in-home aides who provide Medicaid long-term services and supports to also actively promote flu vaccines, preventive screenings, evidence-based falls prevention, and diabetes management activities;
· Having care coordinators or in-home aides who provide Medicaid long term services and supports assist enrollees with managing Medicare-covered medical appointments to help reduce missed treatments;
· Training in-home aides — who often cook meals for their clients — on meal preparation for individuals with nutrition-sensitive conditions, like diabetes.