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On Dec. 18, the Center for Medicare and Medicaid Innovation (CMMI) released information on the Medicaid managed care (MCO)-based Direct Contracting Entity (DCE) track for the Professional and Global Options of the Direct Contracting demonstration. This new MCO track is intended to address the needs of individuals dually eligible for Medicare and Medicaid, many of whom are simultaneously seriously ill and from traditionally underserved communities.
This patient population has historically received fragmented, uncoordinated care, and C-TAC supports efforts to use innovative payment and care models to address their unmet health and social support needs.
To participate in the Direct Contracting Model as an MCO-based DCE, the entity must be either a Medicaid MCO or a legal entity that is affiliated with a Medicaid MCO under common ownership. Eligible applicants must be either 1) MCOs that have Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) or Medicare-Medicaid Plan (MMP) contracts with CMS, or 2) entities that are affiliated under common ownership with an entity that has the FIDE SNP or MMP contract with CMS. They must also cover long-term supports and services (and specifically be at risk for nursing facility costs) and/or behavioral health services for people with serious mental illness/substance use disorder – unless the state managed care program excludes such individuals.
MCO-based DCEs will begin participating in the model in January 2022. For more on this model, click here.