CMS should downsize demonstration programs for dual eligibles, senator says

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Sen. Jay Rockefeller (D-WV)
Sen. Jay Rockefeller (D-WV)

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.

In separate letters sent to government health officials, both the Medicare Payment Advisory Commission and Sen. John D. Rockefeller (D-WV), said he was skeptical that the 26 participating states can administer such a large-scale program.

Under the demonstration, states can sign up for one or two new payment models. One model would allow CMS, a state, and a health plan to integrate care for beneficiaries dually eligible for Medicare and Medicaid. The health plan will receive a blended Medicare and Medicaid capitation rate.

In a letter to Health and Human Services Secretary Kathleen Sebelius, Rockefeller wrote that the programs emphasize savings over high-quality care. He recommended that the Centers for Medicare & Medicaid Services test the payment model in a limited number of states instead.

In a letter from MedPAC to CMS Acting Administrator Marilyn Tavenner, commissioner Glenn M. Hackbarth echoed Rockefeller's concerns, writing “By conducting the demonstrations in a limited number of states CMS could establish methodologically sound tests of key concepts without enrolling millions of beneficiaries.”

Click here to read MedPAC's letter, and here to read Rockefeller's letter.