Capitated payments popular in states participating in dual eligible demonstration

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Melanie Bella, Director of CMS's Medicare-Medicaid Coordination Office
Melanie Bella, Director of CMS's Medicare-Medicaid Coordination Office

Of the states participating in federal demonstration programs that coordinate care for dual eligibles, most are pursuing a capitated payment model, a government official said this week.

Twenty-six states have expressed intent to participate in a Centers for Medicare & Medicaid Services demonstration that would better integrate care for individuals who are eligible for both Medicare and Medicaid, according to Melanie Bella, director of the CMS Medicare-Medicaid Coordination Office. Nursing homes have a vested interest in these demonstration projects as a large number of residents are dual eligibles.

In a presentation at the National Medicare-Medicaid Payment Summit on Wednesday, Bella said 18 of those 26 states would pursue a capitated payment model, while six states have signed up for the fee-for-service model, the Bureau of National Affairs reported. Under the capitated approach, the state, CMS and a health insurance plan would take part in a three-way contract that pays a blended capitated rate for the full continuum of benefits.

As of May 30, 26 states had publicly posted their proposals, a step CMS requires. Of those, only 15 states had sent their proposals to CMS, Bella said. The remaining proposals were due May 31.

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