CMS To Develop Guidelines for Integrating Dual-Eligibles' Data

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CMS is preparing to overhaul the data systems that states use to coordinate care for individuals who are dually eligible for Medicare and Medicaid and develop guidelines to make the systems more effective, Modern Healthcare reports. 


Nearly 10 million individuals are eligible for both programs.

According to Modern Healthcare, these individuals tend to be sicker than other beneficiaries enrolled in the programs. For example:

  • 50% of such individuals have three or more chronic conditions; and
  • 60% have cognitive limitations.

Treating dually eligible beneficiaries costs CMS more than $300 billion per year.

Need for Overhaul

According to Modern Healthcare, a lack of care coordination and disjointed data systems between Medicare and Medicaid largely are responsible for the high cost of covering dually eligible beneficiaries.

In addition, data tracking between the two programs is hindered by:

  • Frequent changing of Medicare beneficiaries' IDs; and
  • Sporadic delivery of Medicare Part D data.

Details of Changes

In a search notice issued last month, CMS said it will enlist several consulting companies to help develop guidance for states to address dually eligible beneficiaries' data by:

  • Consolidating databases;
  • Integrating multiple datasets; and
  • Obtaining data used in care coordination.


Julie Kaviar -- a spokesperson for the Massachusetts Department of Health and Human Services -- said that adhering to uniform guidelines would "support capacity for closer to real-time care management for health plans and providers" and allow "[a]ccess to readily available linked data."

Some states -- such as Colorado and Massachusetts -- already have developed their own plans and hired vendors to integrate dually eligible beneficiaries' data (Dickson, Modern Healthcare, 1/9).

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