A new proposal from America's Health Insurance Plans outlines three options (PDF) for states to better coordinate care for the population of patients eligible for both Medicare and Medicaid.
AHIP suggests options on dual eligibles' care
The report, released on Wednesday, incorporates six models into three approaches states could take. The first option calls for health-plan participation in fee-for-service models that move toward integrating Medicare and Medicaid; the second would combine health plans with fee-for-service programs to advance that integration; and the final alternative describes a capitated health-plan model to integrate the two programs.
The proposal also included 10 “building blocks” that the association says are necessary to implement these models of care for the dual-eligible population. These include stakeholder engagement to involve beneficiaries, health plans and providers; a detailed quality strategy; a single, integrated appeals process for dually eligible beneficiaries that incorporates timeframes and elements of existing Medicare and Medicaid appeals processes most favorable to beneficiaries; and a recommendation that the roles of federal and state governments be defined clearly to avoid duplication in oversight.
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