CMS-NYS Making Medicaid More Coordinated, Person-Centered

The Centers for Medicare & Medicaid Services (CMS) announced that CMS is partnering with the New York State Department of Health (NYSDOH) and the Office for People with Developmental Disabilities (OPWDD) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.

"We are pleased to partner again with the State of New York to bring more person-centered care to Medicare-Medicaid enrollees," said CMS Tim Engelhardt, Director, CMS Medicare-Medicaid Coordination Office.  "We look forward to working together to provide Medicare-Medicaid enrollees with intellectual and developmental disabilities an opportunity to experience more integrated benefits and coordinated care."

Quality Health Care Trumps Volume

The federal government’s drive to reshape health care in America continues to take shape with the latest shift to value-based payment.

The Centers for Medicare and Medicaid Services (CMS) recently set a time line for having half of all Medicare payments based on the value of the care provided, not simply the volume of services. While CMS is often the leader in setting quality and value metrics, health plans have also set pay-for-performance metrics for their policy holders, and, most recently, the New York State Department of Health has set value metrics for Medicaid under the Delivery System Reform Incentive program.

Higher Payments May Prompt More New Jersey Doctors to Accept Medicaid Patients

A two-year project is under way to encourage primary care doctors to accept Medicaid-eligible patients by paying for many services at the same level as Medicare.
Many poor or disabled patients have limited access to healthcare because so few doctors have been willing to accept the low Medicaid reimbursement rates.
The federal government will cover the difference between Medicare and Medicaid reimbursements for 146 primary-care services from Jan. 1 through the end of 2014. The increased payments will be made to family physicians, pediatricians and internal medicine doctors who specialize in primary care.

Brain-Injured Suffer Major Treatment Gap

Larry Boswell sat slumped in a wheelchair. His sweatpants were soiled, his T-shirt soaked in saliva. Flies buzzed around his head.

He was able to walk when he arrived at Illinois’ Cobden Rehabilitation and Nursing Center in 2008, government records show, something he can’t manage now. Speech therapy for the 57- year-old ended shortly after he was admitted, according to a lawyer trying to persuade Medicaid to transfer him.
While much of what Boswell says is incomprehensible, he managed a clear “no” when asked if he wanted to stay where he was. Cobden officials didn’t respond to telephone calls.
Boswell is one of nearly 244,000 brain-injured people consigned to nursing homes, according to data compiled by Bloomberg from U.S. Medicare and Medicaid statistics. He’s also on the front line in a national battle to get people like him out of facilities that aren’t equipped to care for them.

500 Practices Selected for Primary Care Demo

WASHINGTON --  More than 2,000 physicians and health professionals will care for Medicare, Medicaid and private plan beneficiaries under the same new payment model aimed at coordinating care and keeping patients healthy to avoid costly admissions for inpatient care.

Roughly 500 physician practices in seven regions spread out over eight states successfully applied to participate in the Centers for Medicare & Medicaid Services-led comprehensive primary care initiative. Doctors will receive as much as $40 per high-risk patient per month to support care coordination and wellness programs. Practices that keep health spending below expenditure targets will share in the savings, but those that do not meet expectations might be asked to leave the project.