The Medicare Payment Advisory Commission (MedPAC) devoted an hour and one-half to discussion about the proposals to integrate and coordinate care for individuals who are dually eligible for Medicaid and Medicare (Duals) that states are designing. Commission members expressed concern about automatic enrollment of Duals in managed care plans. The Commission Chair, Glenn Hackbarth, said that matching health plans with beneficiaries who have complex health needs will be critically important. The Centers for Medicare and Medicaid Services (CMS) has estimated that the demonstrations will enroll up to two million (20%) of the nation’s Duals. Another commissioner wondered where Duals who choose to opt out of managed care plans would go – would there be something to opt into. Commissioners also discussed the size of the demonstrations and wondered where comparison groups would be if a state plans to enroll all of its Duals in the demonstration. One commissioner thought that the proposals were more like Medicaid waivers than Medicare demonstrations. Although commissioners expressed unease about the demonstrations, they concluded the discussion by emphasizing the need to change the status quo which does not necessarily ensure quality care and is very costly.
Executives of State Chapters of The Arc in states that are designing integrated healthcare plans for people eligible for both Medicare and Medicaid (Duals) met with officials from the Centers for Medicare and Medicaid Services (CMS), the Administration on Developmental Disabilities (ADD), and The Office on Disability. CMS is working with several states as they redesign their systems of healthcare for Duals in an effort to improve care and reduce costs. Approximately, one-third of Duals are individuals with disabilities. The state chapter executives shared their vast experience in designing services and supports for individuals with I/DD with federal officials. Numerous suggestions were offered concerning essential, non-negotiable elements that must be made part of any healthcare design that integrates medical care and long term services and supports for individuals with I/DD.
The Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin concerning billing individuals who are eligible for both Medicare and Medicaid (dual eligibles) for health care costs not covered by either program. The Qualified Medicare Beneficiary (QMB) is a Medicaid program that pays for Medicare premiums, deductibles and co-payments for individuals with low incomes. Providers of Medicare services are prohibited from billing QMBs for deductibles, coinsurance, or copayments.
CMS released an Informational Bulletin concerning Section 3309 of the Affordable Care Act which eliminates Medicare Part D cost-sharing for full benefit dual eligible individuals receiving home and community-based services in lieu of institutional services. Section 3309 became effective on January 1, 2012.