Thursday, February 14, 2013

Additional info on the Dual Eligible Demonstration

I wanted to send out another post on the Dual Eligible Demonstration, since there seems to be some confusion around it.  Specifically, I want to share what we think consumers, providers and families should know.

Several of our Dual Eligible consumers have received letters from our local Regional Care Collaborative Organization (RCCO, commonly pronounced ree-koh).  Here is a useful definition of what a RCCO is from the website:
The RCCO connects Medicaid clients to Medicaid providers and also helps Medicaid clients find community and social services in their area.  The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care.  A RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery.  A RCCO helps with other care transitions too, like moving from children's health services to adult health services, or moving from a hospital to nursing care.
There are seven different RCCOs for the State of Colorado, and like Community Centered Boards (CCBs) each serves a geographical area.  The RCCO for our geographical area (region 6) is called the Colorado Community Health Alliance (CCHA).  The letters that some of our Dual Eligible consumers have received are actually from CCHA.  These letters are being sent to inform the consumer that she or he will be passively enrolled in the Dual Eligible Demonstration project unless they contact CCHA to opt out of the program.  That means that if the consumer takes no action then she or he will be enrolled in the program.  This is a technique that is being used to ensure that a large number of individuals participate in the Demonstration.

Overall, we think that the Dual Eligible Demonstration is a positive thing, in that it will help streamline care for individuals being served by both Medicaid and Medicare.  However, we encourage each consumer or guardian that receives this letter to contact CCHA and confirm that their primary care physician is indeed participating in the Demonstration project.  We have heard from another agency that a consumer was enrolled in the program and later found out that their primary care physician was not participating.  We have been assured by the State that individuals should not be receiving these letters unless their primary care physician is participating, but we still urge individuals or their guardians to find out for sure before enrolling.

If you have any further questions about the program, click here to access the website page about it, which explains the project in much greater detail.