Healthcare Business News

HHS aims to aid states with dual-eligibles' care

By Jessica Zigmond
Posted: July 8, 2011 - 3:15 pm ET

HHS on Friday announced three different initiatives the agency says are intended to help states improve care and lower costs to care for the 9 million Americans who are eligible for both Medicare and Medicaid, also known as dual-eligibles.

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In the first initiative, the CMS' Center for Medicare and Medicaid Innovation will test two demonstration models to align the financing between Medicare and Medicaid. One model calls for a state, the CMS and a health plan to participate in a three-way contract in which the managed-care plan receives a blended payment to provide coordinated care. The other demonstration would have a state and the CMS enter into an agreement in which the state would be eligible to benefit from savings that result from managed fee-for-service initiatives that are designed to both improve quality and lower costs. States that meet certain conditions will have the option of pursuing one or both of those models, according to the CMS.

Another initiative, overseen jointly by the innovation center and the CMS Medicare-Medicaid Coordination Office, will center on reducing preventable inpatient hospitalizations among nursing facility residents. According to the CMS, nearly two-thirds of nursing facility residents are in the Medicaid program, and most of those are also in Medicare. This fall, the CMS will select independent organizations to partner with and implement evidence-based interventions at nursing facilities.

Finally, HHS announced a technical assistance resource center, which HHS Secretary Kathleen Sebelius said will provide the guidance states need to improve care and lower costs in the Medicaid program.

Sebelius said the agency's new initiatives are a “sharp contrast” to the House Republican-proposed block grant program for Medicaid, which she said “takes a blunt approach by cutting billions of dollars” while dumping the problem onto states.

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