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A former senior Trump administration official lambasted the decision, calling it a big blow to value-based care. While some healthcare organizations forged ahead with the GPDC model despite the pandemic, others held off until they weathered the storm. CMMI had told interested organizations that they could join the model after the pandemic ended, so many of them decided to wait to apply.
Now many would-be participants are in limbo, as the agency decides the fate of the model or its possible replacement. The uncertainty has created widespread consternation among existing accountable care organizations and all new direct contracting entities backed by managed-care organizations or venture capital firms. Many of them would have applied for the pilot project last year if they knew CMMI would pause new applications for 2022, experts said.
CMS extends joint replacement model for three years
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CMS Center for Medicare and Medicaid Innovation on Thursday signed off on a three-year extension of the Comprehensive Care for Joint Replacement model.
It will now last through the end of 2024. The final rule changes the definition of an episode to include outpatient hip and knee replacements, modifies how the agency calculates target prices and reduces the number of reconciliation periods from two to one. It also makes changes to beneficiary notice requirements, gainsharing caps and the appeals process. Regulators expect the extension to save the Medicare program about $217 million over three years.
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Medicaid MCOs covering dual-eligibles to join direct contracting
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CMS Center for Medicare and Medicaid Innovation will allow Medicaid managed care organizations serving beneficiaries dually eligible for Medicaid and Medicare to take part in its new direct contracting model, the agency said Thursday.
It s the first payment model to enable Medicaid MCOs to coordinate and manage care for beneficiaries enrolled in both Medicaid managed care and Medicare fee-for-service coverage, according to CMMI. The agency wants to encourage Medicaid MCOs to coordinate care to lower Medicare fee-for-service costs by allowing them to take part in direct contracting s global and professional options.