CMS has finalized memoranda of understanding with California, Virginia, Ohio, Massachusetts and Illinois to test a capitated model, according to the report. Washington has received approval to test a managed fee-for-service model.
Under the capitated financial alignment model, the baseline payment for Medicare Parts A and B will be determined using a combination of Medicare Advantage benchmarks and Medicare fee-for-service standardized county rates weighted by whether enrollees transitioning into the project were previously enrolled in a Medicare Advantage plan or a Medicare fee-for-service plan.
Under the Washington project model, providers will keep receiving fee-for-service payments for services covered by Medicare and Medicaid.
Dual eligible beneficiaries are often the sickest and poorest patients covered by either healthcare program, and existing care models typically don’t involve much if any coordination between Medicare and Medicaid, according to the report.
CMS will limit enrollment in the demonstration projects to 2 million beneficiaries. The agency has yet to determine details of the projects such as how they will be overseen and evaluated.
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