As discussed in a recent Center for Medicare Advocacy Weekly Alert (December 17, 2020), the Centers for Medicare & Medicaid Services (CMS) announced a new Geographic Direct Contracting Model demonstration (the “Geo Model”) aimed at coordinating care and clinical management for beneficiaries in traditional Medicare in their region. CMS is currently accepting applications for participating direct contracting entities (DCEs). The Geo Model is slated to begin in January 2022, and will be overseen by the Centers for Medicare & Medicaid Innovation (CMMI), a division of CMS.
According to a Commonwealth Fund blog post assessing the geo demo, “[t]his model will have the effect of enrolling Medicare beneficiaries into a managed care–like plan; it is one of the most significant changes to the way Medicare beneficiaries receive health care since managed care was introduced into Medicare in the 1970s.
In our Alert, we stated that “[i]n many ways, the “Geo Model” appears to turn more of the federal Medicare program over to private insurers – privatizing the Medicare program even beyond the growth in Medicare Advantage […] This new Model would actively target the still-majority of Medicare beneficiaries who choose not to enroll in private, managed care plans, and, in effect, force them to do so.” The Center urged the incoming Biden Administration to suspend implementation of this demonstration.
In a January 29, 2021 sign-on letter, several national non-profit organizations joined the Center for Medicare Advocacy in urging the Acting Secretary of the Department of Health and Human Services to suspend implementation of the geo direct contracting model. The Center was joined by Aging Life Care Association, Justice in Aging, Medicare Rights Center, National Adult Day Services Association (NADSA), National Association of Social Workers (NASW) and National Council on Aging (NCOA).
The letter noted that “[b]ased on the information available to date, we are concerned about issues surrounding oversight and accountability of DCEs.” The letter also questioned the model’s “rushed roll-out” and outlined “a number of unanswered questions and unaddressed issues surrounding the demo […]” and concluded by “respectfully request[ing] that the Biden Administration pause implementation of the Geo demo until, at the very least, these issues and questions have been resolved.”
February 4, 2021 – D. Lipschutz