Applications for Groups to Manage Health Care for 'Dual Eligibles' Wanted in Massachusetts

July 2nd, 2012 by admin in

Deval Patrick’s administration put out a call for bids from organizations interested in managing the health care of approximately 111,000 low-income residents of Massachusetts who have complex and expensive medical needs. The group of people this program would help includes people age 21 to 64 that are disabled and are covered by both the Medicaid and Medicare programs. Being covered by both can be confusing for patients, lead to fractured care and complicate communication among providers.

Governor Deval Patrick said, “This initiative will improve health outcomes for some of our neediest residents. By emphasizing integrated, community-based care, Massachusetts will again lead the nation in providing comprehensive, cost-effective care.”

The state spent about $3 billion on “dual eligibles” in 2010, so there are billions of dollars up for grabs by groups interested in becoming an integrated care organization. The organizations chosen would begin registering patients in January 2013, and coverage would begin in April.

Dual eligibles will be automatically enrolled, but can opt out of the program, and the organizations can be for-profit or nonprofit. The organizations will be responsible for networking with providers and creating care teams that will focus on long-term support, such as at-home assistance and transportation.

Dennis Heaphy, co-chair of the coalition Disability Advocates Advancing Our Healthcare Rights, said “We view this as a once-in-a-generation opportunity to provide services that give voice to the priorities of the disability community. Right now there is no voice.” He also said that the organizations chosen should focus on preventative care to avoid hospitalizations.

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• Filing the initial claim
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• Reconsideration hearings
• Administrative appeals

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Cited Sources:

State calls for applications for groups to manage health care for ‘dual eligibles’ , boston.com, June 19, 2012