Redesigning the nation’s patchwork approach to delivering long-term services and supports to dually eligible individuals is the goal behind two proposals.
Reps. Mike Kelly (R-PA) and Ami Bera, MD (D-CA) introduced the House of Representatives version of the Delivering Unified Access to Lifesaving Services, or DUALS, Act last week. The proposal is the companion bill to S 3950 introduced early this year by Sen. Bill Cassidy, MD (R-LA).
The bills aim to address perceived shortcomings in the current approach to delivering LTSS.
“For too many older adults, particularly those with low incomes and multiple, chronic health conditions, accessing care and services through Medicare and Medicaid is a fraught endeavor that ends in frustration and — worse yet — inadequate results,” LeadingAge President and CEO Katie Smith Sloan said in a statement about the Senate version of the bill. “This legislation is a start at redesigning our current patchwork approach of delivering long-term services and supports.”
The proposals incorporate elements LeadingAge recommended in 2017 related to dually eligible individuals, including the creation of comprehensive care plans and interdisciplinary care teams, elements Sloan said are “critical to delivering an integrated experience” leading to better outcomes and quality of life for recipients.
Specifically, the bills would provide a single care coordinator for each beneficiary, standardized health risk assessments, individual comprehensive care plans and a single pooled payment system. Under the bills, each state would be required to implement a comprehensive, integrated health plan for dual eligible individuals to ensure access to an integrated set of services providers, rules and payment.
LeadingAge published another report in 2017 detailing key elements of the LTSS financing mechanism it recommended in 2016, including creating a universal, catastrophic insurance program to finance the needs of those who need LTSS, and a managed cash benefit to pay for service delivery.
More than 12.5 million low-income or disabled adults qualify as dually eligible for both the Medicare and Medicaid programs, according to LeadingAge.
