CMS Weighs in on Enrollment Question

by David Gorn

TOPIC ALERT:

Federal health officials have informed the state that CMS would favor passive enrollment with an opt-out provision but it does not support lock-in enrollment for the dual-eligible demonstration project in California.

That's according to Kevin Prindiville, deputy director of the National Senior Citizens Law Center in Oakland, who spoke to CMS officials on Friday.

"CMS has told us that's all they will allow," Prindiville said. "It's not a big surprise, but it's very welcome. We think the passive enrollment system is problematic in some ways, but CMS has said all along they would allow passive enrollment, but there would have to be a way to opt out at any time."

The state, however, is still keeping that piece of the duals puzzle in place, because the determination wasn't necessarily a final one, according to Norman Williams, deputy director of public affairs for the Department of Health Care Services.

"It was not a final determination," Williams said. "So for now, that remains part of our proposal."

In related news, state officials Friday proposed a three-month delay in the start date for the duals demonstration project, which would eventually move about 1 million Californians who qualify for both Medicare and Medi-Cal into a Medi-Cal managed care system.

The dual eligibles demonstration project, also known as the Coordinated Care Initiative, was slated to begin in March 2013. The state now plans to start the program in June 2013.

The lock-in provision of that proposal would mean dual-eligible beneficiaries would be unable switch out of their assigned health plan for a year. That's a long-held concern of federal officials, Prindiville said.

"I did hear that the state might still include the idea of lock-in in their proposal," Prindiville said. "But CMS was pretty clear about their stance on it."

CMS officials could not be reached for comment.

Prindiville said CMS informed California health care officials and some stakeholders of the decision by phone on Friday.

"This is good news [for stakeholders] because the state's program won't be approved," Prindiville said. "If the health plans are working well for people, they can stay in, but if they're not working well, people can go somewhere else. Plans now know they have to do well, because people can vote with their feet."

Prindiville added that the change in start date for the duals program is an extremely positive sign from the state.

"We think the start date should be the date when the state is ready for this program," Prindiville said. "As that [start] date gets closer, the more time we have, the more likely we are to get it right."

Williams said the postponement was entirely a response to stakeholder concern.

"We're being very careful in our approach, and listening carefully to stakeholders," Williams said. "We hear them, and we have a real need to get their input. It's an important part of this process."


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