Data mandated for dual eligibles outlined as states move to managed care

McKnight’s Long-Term Care News & AssistedLiving    


June 10, 2013


[Data mandated for dual eligibles outlined as states move to managed care.]

Dual eligible managed care plans involved in an upcoming Centers for Medicare & Medicaid Services demonstration project will need to submit data in a variety of areas, the agency explained in a draft statement last week.

The plans will have requirements pertaining to assessment, care coordination, organizational structure and other areas. One report called for in the “Utilization” section, for example, is on the total number of discharges from a nursing facility, including death, during a report period.

California, Illinois, Ohio, Virginia and Massachusetts will participate in capitated dual eligible models starting in 2014. They will be part of the Medicare-Medicaid Capitated Financial Alignment Demonstration project.

CMS has requested comments by Friday on the demonstration requirements.

In other dual-eligible news, a report from the Congressional Budget Office finds half of those who were full duals in 2009 became eligible for Medicare on the basis of disability or end-stage renal disease — not age. The “Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies” also found states with higher rates of enrollment in beneficiaries Medicare Advantage plans and Medicaid managed care plans were more likely to apply for the “capitated” model of the Financial Alignment Demonstration Project.

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