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Federal Officials Seek Comments on How to Improve Care for Dually Eligible Patients

By Rebecca Adams, CQ HealthBeat Associate Editor

The Centers for Medicare and Medicaid Services is looking for ideas on how to better align and coordinate benefits for people who are eligible for both of the entitlement programs.

Such patients, known as dual eligibles, are some of the most expensive to cover because many of them have multiple chronic conditions. The 2010 health care law (PL 111-148, PL 111-152) created a new office within CMS, the Federal Coordinated Health Care Office, to try to find ways to make the two programs work together better. The goal is to eliminate waste, improve care and save money.

Melanie Bella, who leads the office for the 9.2 million dual eligibles, said that officials hope to open a technical resource center for all states in the near future to help state officials figure out ways to better align the care of Medicaid programs with Medicare. She also encouraged the crowd at an Alliance for Health Reform briefing to submit comments on ways to better coordinate Medicare and Medicaid services for patients in six areas: coordinated care, fee-for-service benefits, prescription drugs, cost-sharing requirements, enrollment and appeals mechanisms. Those comments are due July 11.

Bella's office had opened up the opportunity for comments on May 16 with a request for information. In the request, CMS officials provided a chart summarizing how particular benefits are covered for the dual eligibles through Medicare and Medicaid as a guide for people who want to suggest ways to improve the coordination of those benefits. The government is asking those commenting to focus on six questions as they think through ways to update specific benefits:

  • How can the Medicare and Medicaid programs better ensure dual eligible individuals are provided full access to the program benefits?
  • What steps can CMS take to simplify the processes for dual eligible individuals to access the items and services guaranteed under the Medicare and Medicaid programs?
  • Are there additional opportunities for CMS to eliminate regulatory conflicts between the rules under the Medicare and Medicaid programs?
  • How can CMS best work to improve care continuity and ensure safe and effective care transitions for dual eligible beneficiaries?
  • How can CMS work to eliminate cost-shifting between the Medicare and Medicaid programs? How about between related health care providers?

CMS Request for Comment (pdf)

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