CMS to Allow Managed Care Organizations to Participate in Direct Contracting

CMS to Allow Managed Care Organizations to Participate in Direct Contracting

CMS laid out some examples of how an MCO could use the voluntary direct contracting model, including:

  • Entering into value-based purchasing agreements with nursing facilities that factor in facility hospitalization rates
  • Establishing processes to connect beneficiaries with a primary care provider
  • Targeting care coordination resources toward beneficiaries that have a high risk of Medicare spending
  • Having care coordinators and in-home aides that provide Medicaid long-term services to help enrollees with managing medical appointments.

 

Any MCO that participates in direct contracting needs to get a letter of support from their state Medicaid agency to ensure participation aligns with any state-managed plans.


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