Patrick-Murray Administration Announces First in Nation Comprehensive Health Care Option For Dual Eligible Individuals Approved by Obama Administration

By contributor,

ThePatrick-Murray Administration today announced that Massachusetts is the first state in thenation to receive approval from the Obama Administration to implement a healthcare initiative to improve care and contain cost for 111,000 persons withdisabilities who are dual eligible for Medicaid and Medicare.

MassHealthsigned a Memorandum of Understanding (MOU) with the federal Centers forMedicare and Medicaid Services (CMS) to implement the demonstration to provideintegrated care for individuals who are eligible for both MassHealth andMedicare. Massachusettsis the first state working on similar demonstrations to sign an MOU withCMS.

“Massachusetts has been anational leader on expanding access to health care and controllingcosts,” said Governor Deval Patrick. “By entering this agreementwith the Obama Administration we continue to be a leader in providingintegrated, high quality care for our residents with complex needs.”

Thesigning indicates CMS’s official approval of the Massachusetts demonstration, which willcreate a new option for approximately 111,000 dual eligible individuals betweenthe ages of 21 and 64. Those who enroll in the demonstration will be able toreceive both MassHealth and Medicare services plus additional behavioral healthand community support services through health plans that promote the provisionof integrated care.

"Thanks to this new model ofcare, our sickest patients can now focus on getting healthy rather than gettingfrustrated by a confusing or disjointed healthcare system, said CongressmanEdward J. Markey (D-Malden), dean of the Massachusetts Congressionaldelegation. “Patients with several complex conditions can pose thegreatest challenges for health care providers, and this agreement ensures that Massachusetts once againwill lead the way in improving how this population of patients receives qualitymedical care. I applaud Governor Patrick and the Obama Administration for theirleadership on this important issue."

"Massachusetts is once again serving as apioneer in finding innovative ways to provide affordable, accessible healthcare to our residents,” said Congresswoman Niki Tsongas. “I lookforward to working with both the Governor’s administration and theDepartment of Health and Human Services to ensure that this program helpsexpand the options available to individuals to meet their specific health careneeds and provides better, more coordinated care to those who need itmost."

“I’m proud that underGovernor Patrick’s leadership Massachusetts has become the first state toimplement this piece of the Affordable Care Act, which will enhance servicesand provide them in a more efficient manner to patients, while also improvingthe efficiency of the system overall,” said Congressman Barney Frank.“It is nice to have a Governor committed to building on Massachusetts’s role as the nationalleader in health care, rather than one whose main interest appears to be inrepudiating it.”

"I commend the Patrick-Murray Administration for their constantefforts to improve healthcare options while controlling costs," saidCongressman Jim McGovern. "Massachusettsis a national leader in ensuring that residents with complex needs get thehigh-quality care they deserve, and this first-in-the-nation announcement is amajor step forward."

“With this agreement on dualeligibility and integrated care, Massachusettscontinues to distinguish itself as a nationwide leader in controlling risinghealth costs and improving care quality,” said House Speaker Robert A.DeLeo. “This is yet another measure that will assist those who requirehealth care in times of economic recession.”

“Thisagreement emphasizes improved access toward quality that reflects the uniqueneeds of people with disabilities while acknowledging their independence androle in directing their care,” said Secretary of Health and HumanServices Dr. JudyAnn Bigby. “This program will also decrease costs byproviding better coordination of care.”

“One of the primary goals of our recent payment reformand cost containment law is to provide improved health quality throughcoordination of care,” said Senator Richard T.Moore, co-chairman of the Joint Committee on Health Care Financing. ”People withdisabilities deserve the best care in the most cost-effective setting, and thenew ICO model moves Massachusettsstrongly in the right direction.”

"It is a credit to this Administrationfor once again being a leader in ensuring that our citizens with specializedneeds have access to the best possible care,” said Senator Steven M.Walsh, co-chairman of the Joint Committee on Health Care Financing “This initiative will not only improveservices for those enrolled in both MassHealth and Medicare, but will lowertheir health care costs through the coordination of these plans."

InJune, the Patrick-Murray Administration issued a Request for Responses tocompetitively select organizations to serve as Integrated Care Organizations(ICOs) in the demonstration. The selected ICOs will be accountable forproviding MassHealth and Medicare benefits, additional coordinated behavioralhealth services, additional community support and independent living services.Following the selection process, the ICOs will enter into contracts with HHSand CMS, and will begin accepting enrollments in January 2013 for coverageeffective April 1, 2013.

ICOswill receive a global payment from MassHealth and Medicare and will beaccountable for the total care of each enrollee. The global payment willafford ICOs significant flexibility to cover a range of community-basedservices, when recommended by the member’s care team, as a means topromote independent living and as an alternative to high-cost traditionalservices.

“Thisinitiative will help test a new model for improving and simplifying health carefor individuals enrolled in both Medicare and MassHealth,” saidMassHealth Director Dr. Julian Harris. “Providers will have flexibilityunder this integrated system to consider an individual’s full needs andunique circumstances and to tailor a care plan to meet them.”

Underthe demonstration, members will receive clear and accessible information fromMassHealth and Medicare about their enrollment choices, and MassHealth willmanage enrollments and disenrollments for the ICOs. They have the optionof maintaining their current providers and will have the ability to change ICOsor opt out of the demonstration at any time.

Thesemeasures, together with market innovations in integrated care, new cost-sharingmodels enabled by the federal Affordable Care Act and renegotiated contractsbetween some insurers and providers, have helped Massachusetts make significant progress incontrolling health care costs. Governor Patrick recently worked with theLegislature to enact a cost-containment law that will give the industry moretools to continue moving toward the kind of integrated care that rewards thequality of care, not the quantity.