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Federal and state governments should ensure that beneficiaries enrolled in MCOs for Medicare, Medicaid, or both are allowed to change plans or return to fee-for-service (FFS) arrangements at any ti
When dual-eligibles are enrolled in managed care for Medicaid benefits, Medicare benefits, or both, state and federal governments must ensure that all statutorily required benefits are covered by t
To the extent possible, states and the federal government should ensure that all MCOs honor beneficiaries’ desire to maintain a continuous relationship with a high-quality provider or health plan.
States and the federal government should ensure that MCOs (including those participating in duals demonstrations) seek to improve the quality and value of care for dual-eligibles.
States, in partnership with the federal government, must have sufficient capacity to monitor MCO compliance effectively and take corrective action where necessary.
Federal and state governments must ensure that all models of care designed to enhance beneficiary experience, improve quality, reduce unnecessary service use, and lower costs for duals (including f
Federal and state governments should ensure the care that dual-eligibles receive through MCOs and other delivery models is coordinated and delivered in a person- and family-centered manner.