News You Can Use

April 26, 2012

New Kaiser Policy Briefs on Dual Eligibles

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured has updated three new briefs on issues related to the Medicaid Medicare beneficiaries, better known as “dual eligibles.” The first brief, The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare, looks into the Medicare and Medicaid data to examine dual eligibles' utilization and spending for both programs in 2007. An analyses done by Health Affairs on this first brief reveals that while the cost for dual eligibles is high and accounts for a substantial portion of the Medicaid and Medicare spending, it is even more critical to identify the high-cost of subpopulations within the duals population to create a targeted and effective system of care.

The second policy brief, An Update on CMS’s Capitated Financial Alignment Demonstration Model for Medicare-Medicaid Enrollees, explains key features of the capitated financial alignment model, including information provided in the new guidance concerning key elements that advocates are focusing on, such as financing, enrollment, provider network adequacy, medical necessity determinations, appeals, and quality and oversight. To date, 21 states are pursuing the capitated financial model or both, the capitated and the managed fee-for-service financial model.

The last policy brief delves into the Massachusetts’ proposal to CMS to create an integrated service delivery and payment model in that state. Massachusetts was the first state to submit their proposal to CMS.

Maryland Receives Rebalancing Funds

Under the Balancing Incentives Payment Program (BIPP), Maryland is the second state to receive new Medicaid grant dollars of more than $106 million over a three-year period. BIPP, which was created by the ACA, encourages states to shift their Medicaid long-term care dollars away from institutions and toward Home and Community Based Services (HCBS). Funding is available for states that spend less than 50 percent of their long-term care budget on HCBS. States that meet the program requirements are eligible to receive either a 2 or a 5 percent increase in the Federal Medical Assistance Percentage (FMAP) for their HCBS. This is a great opportunity for states to provide services to beneficiaries so they can manage their conditions at home while living independently and lowering their Medicaid costs as well.

New Measures Added to Medicare’s Value-Based Purchasing Program.

Starting in October 2012, Medicare will restructure how it will pay hospitals based on quality metrics and patient feedback. The initiative is the beginning of a transition from paying hospitals based on the amount of care they provide. Now, in a new proposed rule, Medicare will add two additional measures to the reimbursement policy: patient safety and financial assessment. The new measures will take into account rates of blood infections, rates of preventable complications, and how much Medicare spends on an average hospital beneficiary in the three days preceding the individual’s hospital stay, during it, and the 30 days following it.