Skilled nursing facilities find new opportunities, new challenges with 60% rule

The Centers for Medicare & Medicaid Services recently released a tool for states that want to integrate and coordinate Medicare and Medicaid services for dual-eligible beneficiaries.

The “State Plan Preprint for Integrate Care Programs” allows states to demonstrate and explain their arrangements with Medicare Advantage Special Needs Plans (SNPs) that also are providing Medicaid services. The document also gives states “the opportunity to confirm that their integrated care model complies with both federal Medicaid statutory and regulatory requirements,” according to a letter from Herb B. Kuhn, acting director of the Center for Medicaid and State Operations. Many nursing home residents are dual eligibles, or those who are eligible for Medicare and Medicaid.

Kuhn notes that the preprint does not replace the need for states to operate under the appropriate Medicaid statutory authorities. States also will need to follow the usual process for submitting Medicaid waiver applications and contracts. They can use the preprint on a voluntary basis, Kuhn wrote.

For more on the letter and the preprint, go to http://www.cms.hhs.gov/SMDL/SMD/list.asp#TopOfPage.