CMS Eyes Initial Voluntary Enrollment In Ohio Duals Demo After Okaying Policy In Massachusetts


Ohio is talking to CMS about leaving enrollment in the duals demonstration voluntary for the first three to six months, a private insurance official following the process tells Inside Health Policy, which would be the same approach taken by Massachusetts, the only state so far to sign a duals demo memorandum of understanding with CMS. There likely will be a one-year transition for those in the Ohio demo, during which the dual eligibles will be allowed to continue seeing their current providers.

Up to now Massachusetts is the only state to sign a duals MOU with CMS. That MOU included a three-month voluntary enrollment period, followed by “passive enrollment,” the term states use for automatically enrolling beneficiaries, then letting them opt out. Ohio also would use passive enrollment after the initial voluntary phase.

The insurance company official says the phase-in helps both beneficiaries and the plans. It lets beneficiaries participate immediately if they like while giving others time to learn about the demo. For the plans, it makes it easier to enroll a large group of people. In Ohio, one of the duals-special needs plans would have to hire about 200 employees to form the “care teams” that clinically integrate duals into the plan’s network.

However, allowing beneficiaries to stay with their current providers helps only beneficiaries, the source says, and this aspect of the demo is being pushed by patient advocates. Duals placed into managed care may be forced to move to different nursing homes or have to switch other providers if those providers are not in the network of the managed care plan. The one-year transition gives them time to either opt out or at least prepare for switching providers.

Plans do not have to contract with providers during the first year, the official says. The one-year provider grace period makes it more difficult for plans because they are being payed a capped amount, yet during the first year, plans are not allowed to shift beneficiaries to providers that the duals-special needs plans view as better or less expensive.

Duals in hospice and those receiving dialysis for liver failure likely will be included in Ohio's duals-special needs plans, the official says, although she expects the hospice services to be paid for outside the cap by traditional Medicare fee for service, just as they are today. It's less clear how the end stage renal disease services would be reimbursed.

None of these details are set in stone. Ohio is negotiating with CMS, and the memorandum of understanding between CMS and the state is not expected until the end of November, the official said. That time frame is not designed around the election, the official added. Rather, CMS has a 30-day clearance period, and that period has yet to begin. -- John Wilkerson


Written by:
less on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at:

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.