HHSC is looking for feedback on a demonstration project designed to reduce costs and improve care management for full dual eligibles — people who qualify for full Medicaid coverage due to their income and Medicare due to their age or disability.
The approach HHSC has proposed is a response to an opportunity presented by the U.S. Centers for Medicare and Medicaid Services (CMS) last summer. The CMS Center for Medicare and Medicaid Innovation called on states to propose creative ways to provide integrated care for full dual eligibles, while reducing costs.
HHSC’s proposal calls for a fully integrated, capitated approach to providing care for this population. HHSC would negotiate a three-party agreement between a managed care organization (MCO) that has both an existing STAR+PLUS contract and a contract with the federal government for a Medicare Advantage Special Needs Plan. Through that three-party agreement, full dual eligibles in the MCO’s service area would have access to a full array of Medicaid and Medicare services.
Deadline for commenting on the proposal is 5 p.m. May 11. HHSC is looking for comments on two items included in the proposal, one that would require dual eligibles enrolled in STAR+PLUS to enroll in the their MCO’s Medicare Advantage Special Needs Plan and a second that would include both the Medicare and Medicaid payments (under the STAR+PLUS MCO’s capitation payment) for the first four months of a dual eligible’s stay in a nursing facility.
For more information on HHSC’s proposal and opportunities for comment, visit the Texas Dual Eligible Integrated Care Project on the HHSC website.