Capitated payments popular in states participating in dual eligible demonstration

Share this article:
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.

Share this article:

More in News

Bulk of Medicaid to be managed care in two years: Avalere

Bulk of Medicaid to be managed care in ...

More than three-quarters of Medicaid beneficiaries will be enrolled in a managed care plan as of 2016, according to an Avalere Health analysis released Thursday. The numbers reveal that managed ...

Nursing home asked for employee's personal information too often, jury rules

The human resources department of a Maine nursing home did not properly protect a former employee's personal identification information, a jury recently ruled.

Test could confirm sepsis within an hour

Nursing home residents might benefit from a new way of diagnosing and treating sepsis made possible by discoveries out of the University of British Columbia.