CMS recently testified before the Senate Finance Committee that the beneficiary safeguards will be in place in any approved state demonstration programs for dual-eligible beneficiaries. CMS will conduct a readiness review of all participating managed care plans before the demonstration programs are implemented. In addition, the program will be phased-in and CMS will be monitoring implementation to ensure that all federal and state requirements are met. CMS and the state will perform an assessment of each participating plan’s operational capacity and ability to offer highquality, coordinated care. In Massachusetts, for example, the following health plan operations will be reviewed: assessment, process care, cordiality, program integrity, financial soundness, provider network, and utilization management and enrollee protections. Additional details on the hearing are available here.
In related news, Ohio has reached an agreement with CMS on its dual-eligible demonstration. Ohio’s demonstration will be in effect from September 1, 2013 through December 31, 2016. Dual eligible recipients will voluntarily enroll into one of five health plans participating in demonstration in September 2013. Beyond that, recipients who do not select a plan will be passively enrolled based on region. The plans are open to those persons who are age 18 and older at the time of enrollment, eligible for full Medicare Parts A, B, and D and full Medicaid, and who reside in a county that has been selected for the demonstration.
Participating plans will be subject to a minimum medical loss ratio requirement for Medicare Parts A and B, as well as for Medicaid.