« The Dual Agenda: September 25, 2015 Issue

Noteworthy News

States Indicate Interest in Extending Demonstrations

All 13 states participating in the dual eligible demonstration projects have indicated to the Centers for Medicare and Medicaid Services that they are interested in at least preserving the option of extending their demonstrations for an additional two years. Several states, including Texas and California, used the letter of interest to note a variety of challenges including high opt-out rates and higher-than-expected costs in some areas. However, most agree that it will take time to implement such a significantly different care model for this challenging population, and a five-year time frame is more likely to achieve success than the original three-year time frame.

Medicaid Programs Become Leaders of Innovation

Modern Healthcare reports on the many innovative programs being implemented across the country in state Medicaid programs to address health care cost, quality and access issues. The innovations include integration of primary care and behavioral health, telemedicine, accountable care, patient-centered medical homes and coordination of medical services with long-term care services and supports. According to the article, Medicaid programs provide more fertile ground for experimentation than Medicare or private insurance because of constant state-budget-driven pressure to reduce the costs of the program, the ability of states to be flexible in program design, and the relative political powerlessness of Medicaid beneficiaries, who are less able to mount political resistance to program changes. Given historical problems for Medicaid beneficiaries in finding participating providers, Medicaid innovations hold great potential for increasing access to care.

Obama Administration Moves Forward on Health Equity on Two Fronts

The Obama administration has taken two important steps in advancing health equity. In early September, the Centers for Medicare and Medicaid Services Office of Minority Health (CMS OMH) released its first-ever plan to address health disparities in the Medicare program. The Equity Plan is an action-oriented program that focuses on six priority areas and aims to reduce health disparities in four years. The Plan focuses on Medicare populations that experience disproportionately high burdens of disease, lower quality of care and barriers accessing care. These include lowering barriers in access to care for racial and ethnic minorities, people with disabilities and those living in rural areas, and assuring that access is provided to all people equitably, regardless of sexual orientation and gender identity.

In addition, the US Department of Health and Human Services (HHS) has issued a proposed rule to advance health equity and reduce disparities in health care. The proposed rule establishes that the prohibition on sex discrimination includes discrimination based on gender identity. It also includes requirements for effective communication for individuals with disabilities and enhanced language assistance for people with limited English proficiency. The rule makes clear that individuals can seek legal remedies for discrimination under Section 1557 of the Affordable Care Act. The proposed rule applies to Health Insurance Marketplaces, any health program that HHS administers, and any health program or activity that receives funding from HHS. It explicitly bars any marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, or disability. The comment period on the proposed rule is open until November 9, 2015.  This link provides information about how to submit comments.

CMS Announces New Medicare Advantage Demonstration

The Centers for Medicare and Medicaid Services (CMS) announced in early September that it will move forward with a Medicare Advantage Value-Based Insurance Design (VBID) plan as part of the Health Plan Innovation Initiatives. The VBID Model will begin January 1, 2017 and run for five years. CMS will test the model in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. Eligible Medicare Advantage plans in these states, upon approval from CMS, can offer varied plan benefit design for enrollees who fall into certain clinical categories identified and defined by CMS. Changes to benefit design made through this model may reduce cost-sharing and/or offer additional services to targeted enrollees. 


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