CMS Medicare-Medicaid Coordination Office (MMCO) September Announcements

CMS Medicare-Medicaid Coordination Office (MMCO) September Announcements 

The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to announce the following updates:

• Proposed guidelines for Advance Beneficiary Notices (ABNs) for dually eligible individuals
• Posting of new evaluation reports for four Financial Alignment Initiative demonstrations

Proposed guidelines for Advance Beneficiary Notices (ABNs) for dually eligible individuals

On August 20, 2019, CMS proposed modifying instructions for the Advance Beneficiary Notice (ABN) to include guidelines for providing the notice if the beneficiary is dually enrolled in both Medicare and Medicaid, also known as a dually eligible individual.  Providers give an ABN, in order to transfer potential financial liability, to a Medicare beneficiary and convey that Medicare is not likely to provide coverage for a particular service or item. CMS does not propose changes to the ABN form itself.

CMS will accept comments on this issuance until October 21, 2019. You can find the federal notice by visiting https://www.govinfo.gov/content/pkg/FR-2019-08-20/pdf/2019-17945.pdf and the form instructions and supporting materials are available at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-R-131.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.

Posting of new evaluation reports for four Financial Alignment Initiative demonstrations

On September 24, 2019, CMS released evaluation reports for four demonstrations under the Medicare-Medicaid Financial Alignment Initiative. These include the first evaluation reports for the demonstrations in Michigan, New York and South Carolina, and the third evaluation report for the demonstration in Washington State.

The reports are available on the MMCO website at:

https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Evaluations.html

Including these reports, CMS has posted a total of 15 evaluation reports covering ten demonstrations under the Financial Alignment Initiative. Reports for six of those 10 demonstrations include regression-based service utilization results for the demonstration-eligible population relative to a matched comparison group. Eight reports include regression-based Medicare Parts A & B cost savings results.  

In addition, CMS has posted the fourth Medicare Parts A & B cost report for the Washington demonstration, which uses an actuarial methodology instead of the regression-based approach used in the comprehensive evaluation reports. The actuarial results roughly aligned with those in the evaluation reports, indicating a gross reduction of Medicare expenditures of $167 million from 2013-2017 (though the 2017 results are preliminary).