CMS looks to improve care for dual-eligibles

The CMS is asking Medicare Advantage and prescription drug plans to submit ideas on improving care for people who are dually eligible for Medicare and Medicaid. The agency wants to develop unified grievance and appeals processes for those enrolled in Dual Eligible Special Needs Plans, known as D-SNPs, and establish new standards for people in such plans.

Duals tend to have fragmented care experiences, leading to higher use of health services. In 2012, these patients cost states and the federal government $306 billion. By 2016, there were 11.7 million enrolled in both Medicare and Medicaid. That same year, just under 2 million people were enrolled in D-SNP plans, according to consulting firm Open Minds.

Patient advocates say D-SNP plans don’t offer an integrated care experience, leading some dual-eligibles to seek fee-for-service coverage.

Combining appeals for Medicare, Medicare Part D and Medicaid services could alleviate confusion, inefficiencies and administrative burden for beneficiaries as well as state and federal government, advocates say.