The CMS' test of improved care coordination for low-income, disabled Americans covered by both Medicare and Medicaid has faced a lot of challenges. Now, the federal official in charge has revealed one more: Some healthcare providers are trying to dissuade beneficiaries from participating. She said her agency has increased its surveillance of these providers.
“We are, unfortunately, seeing lots of bad behavior in most of the states,” Melanie Bella, director of the Medicare-Medicaid Coordination Office at CMS, said during a National Association of Medicaid Directors gathering this month. “Providers and other plans are telling beneficiaries they are going to lose benefits or prescription-drug coverage.” Beneficiary participation is voluntary.
In Virginia, the state Medicaid agency has faced resistance from a number of providers, including hospitals and nursing homes, said Cindi Jones, Virginia's Medicaid director. A spokesman for Jones' agency later said that the agency is “speaking to the identified providers and explaining which activities are not allowed.”
“We communicated with our membership that the basic rule was that they could only be factual in their discussion of (the coordinated-care demonstration),” said Steve Morrisette, president of the Virginia Health Care Association.
Some hospitals, physicians and nursing homes likely are resisting the demonstrations because the CMS is moving away from a lucrative, unmanaged, fee-for-service payment model, a CMS spokeswoman said following Bella's remarks.
Medicaid officials are concerned that if the test demonstrations don't get enough participants, it will be hard to evaluate whether the dual-eligible managed-care programs reduce costs and improve quality. Total annual spending for dual-eligibles is about $350 billion.
Some of the resistance providers are putting up could have been avoided if the CMS had worked more closely with them originally, Bella said.
There are currently coordinated-care demonstrations operating in five states—California, Illinois, Massachusetts, Ohio and Virginia. Demonstrations under the CMS' Financial Alignment Initiative also are slated to begin soon in Michigan, New York, South Carolina, Texas and Washington state.
California's Medicaid organization has faced similar issues.
“We have worked quickly to address issues and misinformation that may have been shared by providers so we can ensure that dual-eligibles are able to make informed choices,” said Anthony Cava, an agency spokesman.
