Medicare Watch

Panel Speaks to Senate About Integrating Care for Dual-Eligibles

This week, the Senate Special Committee on Aging held a public hearing on integrated care for the nine million people who are enrolled in both Medicare and Medicaid, also known as dual-eligibles. Among the panel of witnesses was Melanie Bella, Director of the Medicare-Medicaid Coordination Office (MMCO) at the Centers for Medicare and Medicaid Services (CMS), and Jason Helgerson, New York State Medicaid Director. While all witnesses discussed the need for better integration of Medicare and Medicaid services for duals, they also expressed the different experiences states have had with the dually eligible population and varying ideas for how best to provide integrated care while reducing costs.

MMCO Director Melanie Bella spoke to the many efforts underway at CMS to provide coordinated care for dual-eligibles, namely demonstrations such as the Financial Alignment Initiative, which allows states to administer Medicare and Medicaid services to duals through either a capitated or managed fee-for-service model. Twenty-six states, including New York, have submitted demonstration proposals to CMS under this initiative. While members of Congress questioned the size and scope of these proposed demonstrations (CMS aims to target two million dual-eligible beneficiaries through these state demonstrations), Ms. Bella responded that the size is necessary to ensure that CMS acquires sufficient data about delivery systems, variation across states, and how to better integrate care. Ms. Bella also stressed that strong evaluation and oversight will continue to be part of the demonstrations and will protect the interests of participating beneficiaries.

New York State Medicaid Director Jason Helgerson spoke to the state’s plans for coordinating care for dual-eligible beneficiaries. According to Mr. Helgerson’s testimony, New York is “well-positioned” to partner with the federal government around integrating care for dual-eligibles. Beginning in 2013, the state plans to use health homes to provide care management for 126,000 duals that do not require long-term care. Then in 2014, the state will expand its managed long-term care program to cover 120,000 dual-eligibles in a fully integrated managed care model. All dual beneficiaries will have the option to “opt out” of the programs if they wish to, although Mr. Helgerson expressed his belief that beneficiaries will stay in the integrated models.

Read the full testimony from MMCO Director Melanie Bella.

Read the full testimony from New York State Medicaid Director Jason Helgerson.

CMS Proposes Payment Increases for Family Physicians and Primary Care Providers

On Friday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would increase payments to family physicians by seven percent in 2013. The rule would also provide higher reimbursements to other types of physicians who provide primary care services to their patients. According to CMS, the increases are part of a larger proposal to promote high quality, patient-centered care.

The proposed rule would also seek to pay physicians to coordinate care for patients that have been recently discharged from a hospital or skilled nursing facility (SNF). Physicians would receive separate payments to help patients transition back into their communities in the 30 days following discharge. The proposed rule also asks the public to weigh in on how Medicare can better recognize physicians for coordinating patient care, both face-to-face in the physician’s office and outside of the office setting.

The proposed rule would also continue implementation of the Value Modifier, which was included as part of the Affordable Care Act. The Value Modifier adjusts physician payments based on the quality and cost of the care they provide to Medicare beneficiaries. According to CMS, the proposed rule would allow physician groups to choose to have their payment rates adjusted based on performance: physician groups with higher quality and lower costs would be paid more, while groups with lower quality and higher costs would be paid less.

The proposed rule also includes a number of other proposals, including one which would provide additional Medicare-covered preventive services via interactive telecommunications systems. The proposed rule will appear in the Federal Register on July 30, 2012, and CMS will accept public comment on it until September 4, 2012.

Read the CMS release on the proposed rule.

Medicare Reminder

When you travel, whether Medicare will cover your care depends on where you travel and how you receive your Medicare benefits.

If you have Original Medicare, you can travel anywhere in the U.S. and its territories and get the medical care you need from any doctor or hospital that accepts Medicare.

If you have a Medicare private health plan, also known as a Medicare Advantage plan, your plan may only cover your care while you travel in the United States, and only if you require emergency or urgent care. If your plan does allow you to see providers outside of your network, you will usually need to pay more for this care (unless you need emergency care). You should contact your plan to see what rules and costs apply for coverage of services when you travel within the United States.

If you travel to a foreign country, in most cases, Medicare will not cover your medical care. However, Original Medicare and Medicare Advantage plans must cover medical care that you get outside of the U.S. under specific, limited circumstances.

Learn more about Medicare coverage of services when you travel at www.medicareinteractive.org, or call our helpline at 800-333-4114.

Spotlight

The Medicare Rights Center is happy to welcome Stacy Sanders as its new Federal Policy Director. Ms. Sanders brings to this new role critical experience working to build economic security for older adults through national, state and local advocacy campaigns. In her most recent position, Ms. Sanders redeveloped National Neighbors Silver, a multi-year campaign to promote responsible banking and affordable, fair housing for older adults, launched by the National Community Reinvestment Coalition in 2010.

Prior to this, Ms. Sanders led the Elder Economic Security Initiative (Elder Initiative) at Wider Opportunities for Women (WOW). The Elder Initiative combines research, advocacy and outreach to fill the income gap for older adults who are unable to make ends meet. While at WOW, Ms. Sanders created a comprehensive technical assistance program for the Elder Initiative’s 17 state partners and 3,000+ coalition members. She also pursued federal policy goals to strengthen Social Security, reauthorize the Older Americans Act and fight proposed cuts to public benefits for low-income older adults and their families.

Ms. Sanders completed her Master of Social Work from the University of Michigan as a fellow of the Hartford Partnership Program for Aging Education. She is an Executive Fellow of the Center for Progressive Leadership, a member of the National Academy of Social Insurance and served as co-chair of the Income Security Committee of the Leadership Council of Aging Organizations in 2011.