Two-Thirds of States Integrating Services for Dual Eligibles, According to AARP
April 24, 2013 04:27 PM
Two-thirds of states are integrating services for dual eligibles, according to a report issued by AARP this month. Thirty-three states currently have plans to better coordinate care for beneficiaries eligible for both Medicare and Medicaid in State Fiscal Years 2013 and 2014. Of the twenty states providing additional information about expected populations in their programs, nineteen plan to include adult duals receiving home and community-based services (HCBS).
Most state initiatives include a wide range of services, including long-term services and support. Additionally, most states – 25 - are opting for risk-based managed care (RBMC) models, while seven are opting for either a managed fee-for-service (MFFS) or primary care case management (PCCM) models, and one is developing an accountable care organization (ACO) model.
Of the 25 states opting for a RBMC model, 20 states provided information on which services would be included under capitation. Only one state, South Carolina, plans to not include HCBS under capitation. Specifically, HCBS would continue to be reimbursed under fee-for service, despite being “integrated within care coordination functions.”
While integration will transform the way that dual eligibles receive care, many unknowns remain for providers, and home health providers specifically. Full details have yet to emerge regarding specific HCBS services within the states’ initiatives.
That said, home health providers can look to these integration initiatives as opportunities to increase clinical coordination among the dual eligible population. In addition, these initiatives will give home health providers rebalancing opportunities, as a stronger emphasis is placed on community based systems over institutional settings.
Home health providers are encouraged to keep abreast of integration proposals and memoranda of understanding (MOUs) on The Centers for Medicare & Medicaid Services’ (CMS’) website, and to contact NAHC with any questions or concerns.
For the full AARP report, click here.