CMS said it will allow managed care organizations to participate in global and professional options in its direct contracting model, which offers risk-sharing agreements.
This is the first payment model opportunity that helps Medicaid MCOs coordinate care for beneficiaries who are in both Medicaid managed care and Medicare fee-for-service, CMS said.
“CMS believes that dually eligible individuals can benefit from more integrated systems of care that meet all of their needs — primary, acute, long-term, behavioral and social — in a high quality, cost-effective manner,” CMS said in a news release.
“For too long we have struggled to deliver acceptable outcomes for this vulnerable population, but today’s model is a game changer,” CMS Administrator Seema Verma said Dec. 17. “It represents a significant step toward addressing these long-standing issues and ensuring they receive the coordinated care they rightfully deserve.”
CMS will start accepting applications for participants next year.
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