Dual Eligibles

Dual eligibles in nursing homes have fewer hospitalizations than those in home- and community-based care, researchers find

Dual eligibles in nursing homes have fewer hospitalizations than those in home- and community-based care, researchers find

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Elderly, frail people are more likely to be hospitalized if they are receiving home- or community-based services than if they live in a nursing home, according to newly published research. Recent Medicaid reforms have aimed to increase use of HCBS because it is believed to be less costly than institutional long-term care, investigators noted. They said their findings suggest that more frequent hospitalizations are a "hidden cost" of home- and community-based care.

Medicaid-only long-term care residents driving up state expenditures, report finds

Medicaid-only long-term care residents driving up state expenditures, report finds

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Among people eligible for Medicaid but not Medicare, long-term care residents are most likely to be among the costliest beneficiaries for a state, according to a new report from the Government Accountability Office. Sen. Charles Grassley (R-IA) requested the report, noting that much research has focused on those eligible for both Medicaid and Medicare, but has largely overlooked the Medicaid-only group.

Dual eligibles moved out of LTC face risks

Dual eligibles moved out of LTC face risks

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Dual eligibles who move from a long-term care facility to home- and community-based services have a 40% increased risk of a potentially preventable hospital stay.

Transition from facility to home- and community-based care greatly increases dual eligibles' risk of hospitalization, study shows

Transition from facility to home- and community-based care greatly increases dual eligibles' risk of hospitalization, study shows

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Dual eligibles who moved from a long-term care facility to home- and community-based services had a 40% increased risk of a potentially preventable hospital stay, according to recently published research.

The safety net for seniors

The safety net for seniors

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Healthcare reform, especially the expansion of Medicaid, will bring into focus the fragility of the safety net. This is a system that is for vulnerable seniors, but which has not been adequately financed.

Report: Providers should prepare for managed care partnerships for dual-eligibles services

Report: Providers should prepare for managed care partnerships for dual-eligibles services

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Managed care organizations are set to play a bigger role in how long-term care is provided for people currently eligible for both Medicare and Medicaid, and providers should focus on having the right capabilities in place for them, according to a new report. Released by merchant bank TripleTree, it also identifies technology vendors enabling these capabilities in the long-term and post-acute care settings.

Data mandated for dual eligibles outlined as states move to managed care

Data mandated for dual eligibles outlined as states move to managed care

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Dual eligible managed care plans involved in an upcoming Centers for Medicare & Medicaid Services demonstration project will need to submit data in a variety of areas, the agency explained in a draft statement last week.

States ready for Medicaid managed care expansion, but long-term care remains a worry, report says

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Stakeholders in Medicaid managed care programs feel prepared for the enrollment surge that will follow the full implementation of the Affordable Care Act, but there are ongoing concerns related to long-term care and provider capacity, according to a new report.

State, CMS pair up on duals

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The Centers for Medicare & Medicaid Services and the state of Illinois are teaming up in a dual eligible payment demonstration.

Huge opportunity for dual eligible cost savings, report says

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Better coordination of care for individuals eligible for both Medicare and Medicaid could result in savings of nearly $190 billion by 2022, according to a recent UnitedHealth Center report.

Medicaid underpayments soar to an average $22.34 per resident day, report finds

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The cumulative effect of cuts has been "devastating," AHCA President and CEO Mark Parkinson said.

Senate Finance Chairman accuses long-term care providers of 'gaming' dual-eligible reimbursements

Senate Finance Chairman accuses long-term care providers of 'gaming' dual-eligible reimbursements

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Long-term care providers struck back quickly late last week after the chairman of the U.S. Senate Finance Committee accused them of "gaming" the reimbursement system during a hearing on caring for individuals eligible for both Medicare and Medicaid.

Managed care experiment for dual-eligibles set to boom; observers worried

Managed care experiment for dual-eligibles set to boom; observers worried

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A federal experiment for dual-eligibles that hopes to cut Medicaid and Medicare costs through managed care is set to exponentially expand, and some are worried it is destined to fail, according to a report from Kaiser Health News.

Kaiser: Small savings possible in dual-eligible programs

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Attempts to better manage care for "dual-eligible" seniors produced a small savings, according to a study from the Kaiser Family Foundation. The findings show that hopes for a significant decrease in government spending on patients eligible for both Medicare and Medicaid might not be realized.

Increase in dual eligibles under ACA presents opportunity for Medicaid-focused health plans, expert says

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The Affordable Care Act's Medicaid expansion incentives are too attractive for Republican governors to turn down indefinitely, predicted one health policy consultant this week.

Dual-eligibles are happy with Medicare Part D, survey finds

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About 90% of seniors, including dually eligible Medicare and Medicaid beneficiaries, are happy with Medicare's prescription drug program, a new survey reveals.

CMS announces rehospitalization initiative participants

CMS announces rehospitalization initiative participants

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A new federal program aimed at the reduction of hospitalization among nursing home residents, especially dual eligibles, announced seven health system participants Thursday.

Care coordination demonstration achieves big government savings for dual eligibles: report

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One of the first care coordination demonstration projects for Medicare beneficiaries achieved significant provider savings for dually eligible Medicare and Medicaid beneficiaries, a new analysis found.

Care Coordination Summit to attract providers and other stakeholders to annual conference next Friday

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Long-Term care providers should be more interested than ever in what goes on at a daylong, national summit next week dedicated to improving care coordination. The event takes place Sept. 14 at the National Press Club in Washington. Experts will lead participants through sessions that will cover Accountable Care Organizations (ACOs), improving care for individuals certified under both Medicaid and Medicare, and much more. Experts at the point of care will discuss forward-thinking initiatives and innovative best practices. In less than four weeks, hospitals will begin getting penalized financially for rehospitalization rates that are too high, thus making relationships with long-term care providers more important than ever.

Care Coordination Summit to attract providers and other stakeholders to annual conference next Friday

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Long-Term care providers should be more interested than ever in what goes on at a daylong, national summit next week dedicated to improving care coordination. The event takes place Sept. 14 at the National Press Club in Washington. Experts will lead participants through sessions that will cover Accountable Care Organizations (ACOs), improving care for individuals certified under both Medicaid and Medicare, and much more. Experts at the point of care will discuss forward-thinking initiatives and innovative best practices. In less than four weeks, hospitals will begin getting penalized financially for rehospitalization rates that are too high, thus making relationships with long-term care providers more important than ever.

States should have strong oversight over Medicaid managed care programs, report asserts

States should have strong oversight over Medicaid managed care programs, report asserts

Effective oversight is the key to ensuring access to care for states using managed care organizations for elderly and disabled Medicaid enrollees, a new report suggests.

Integrated care coordination for dual eligibles lowers readmission rates in case study

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Dual eligibles in an Arizona integrated coordinated care plan had a 21% lower hospital readmission rate than their counterparts in Medicare fee-for-service programs, a new analysis reveals.

CMS official responds to criticism of pilot programs for dual eligibles

CMS official responds to criticism of pilot programs for dual eligibles

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

CMS should downsize demonstration programs for dual eligibles, senator says

CMS should downsize demonstration programs for dual eligibles, senator says

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Large demonstration programs meant to coordinate the care of dually eligible Medicare and Medicaid beneficiaries could limit access to care and require more thorough testing, critics said this week.

Healthcare expenditures for dual eligibles is double that of Medicare-only beneficiaries, report shows

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Monthly expenditures for individuals eligible for Medicare and Medicaid is nearly two times higher than that of people who receive just Medicare benefits, a new government report finds.

Medicare panel seeks enhanced payments, eligibility for the PACE program

Medicare panel seeks enhanced payments, eligibility for the PACE program

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Program of All-Inclusive Care for the Elderly providers should be paid more generous Medicare Advantage rates, according to a payment panel. The Medicare Payment Advisory Commission also called for changes that would allow people younger than age 55 to participate in the program, which targets dual eligible seniors.

Improving care for dual eligibles could lower rehospitalizations, study finds

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More focused treatment of common illnesses among dually eligible Medicare and Medicaid beneficiaries could cut costs and lower hospital readmissions, researchers found.

Most meds used by dual eligibles are covered by Medicare Part D, OIG says

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The vast majority of the medications used by people who are dually eligible for Medicare and Medicaid can find what they need through Medicare Part D formularies, a federal report finds.

CMS defends 'passive enrollment' into dual eligible demonstration programs

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Government officials say safeguards are in place to prevent dually eligible Medicare and Medicaid beneficiaries from losing access to care when they enroll in demonstration projects.

Capitated payments popular in states participating in dual eligible demonstration

Capitated payments popular in states participating in dual eligible demonstration

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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.

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