Case Study 1: Medicare Options
The CPT data subcommittee recently presented data about the potential target group for the pilot program. In that data James noticed that 93% of Medicaid beneficiaries who are 65 or older, and 59% of those who are under 65 also have Medicare. Now James understands why the Medicaid Director initially wanted to include Medicare in the program, but the directive from the state legislature is clear: Medicare is not to be included.
While disappointed, James does admit to a silver lining in this decision: It will certainly make the program easier to design. At least there’s no need to figure out how Medicare services will be integrated. He still believes, however, that it’s essential to the program’s goals for MLTSS contractors to coordinate closely with Medicare-reimbursed providers, particularly doctors, whose decisions can really impact LTSS.
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If Medicare is not included in the MLTSS, how does James make sure that care coordination happens with Medicare-reimbursed providers?
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