CHA News Article

GAO Recommends Additional Oversight of CMS’ Dual-Eligible Beneficiaries Demonstration

The U.S. Government Accountability Office (GAO) has released a report examining care coordination under the Centers for Medicare & Medicaid Services’ (CMS) dual-eligible beneficiaries demonstration. GAO examined how integrated care organizations — health plans or other entities — are implementing care coordination; what, if any, challenges they have encountered in implementing care coordination; and the extent to which CMS oversees these care coordination activities. GAO recommends that CMS develop new comparable measures and align existing measures to strengthen oversight of care coordination.

The organizations inteviewed by GAO described challenges that affected their ability to coordinate care, such as difficulties in locating beneficiaries. Specifically, organizations noted that certain characteristics of dual-eligible beneficiaries, such as high levels of transience, can make it challenging to coordinate their care — one of the key goals of the demonstration. GAO’s interviews with beneficiary advocacy groups and providers raised questions about the extent to which care coordination is actually occurring.

CHA is actively engaged in advocacy on this issue at the local, state and federal levels and has previously provided the attached comments  to the California Department of Health Care Services on this issue.