CMS official responds to criticism of pilot programs for dual eligibles

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

A federal official defended government demonstration programs that coordinate care for dually eligible Medicare and Medicaid beneficiaries in a Senate hearing Wednesday.

In testimony before a Senate Aging Committee hearing, Melanie Bella, director of the Centers for Medicare & Medicaid Services' Medicare-Medicaid Coordination Office, stressed that CMS has yet to officially approve managed care programs for dual eligibles and enrollment strategies such as passive enrollment.

The CMS programs seek to coordinate care for some of the sickest and frailest Medicare and Medicaid beneficiaries who often are nursing home residents.

In response to the hearing, the American Health Care Association joined other critics of the pilot programs. In a statement Wednesday, AHCA President and CEO Mark Parkinson said Congress should reject the agency's proposals, adding “CMS appears to have led states toward de facto enrollment of all individuals who are fully eligible for Medicare and Medicaid into an entirely new system. This structure is unproven and risks disrupting care delivery to over 9 million Americans.”

Bella said CMS views demonstration projects as experimental.

“There certainly is a lot of interest in the proposals that have all been publicly posted,” she said. The goal is not to have one model. The goal is to have seamless, accountable care.”