A proposed direct contracting model for CMS will explore whether a geographic approach to value-based treatment would improve the standard of care while minimizing costs for Medicaid patients in a single location.

In a recent statement, CMS explained that the Geographic Direct Contracting Model is an option for healthcare providers and other organizations in the region to handle the treatment of Medicare recipients as Direct Contracting Entities (DCEs).

DCEs will bear the responsibility for the overall costs of coverage for Medicare fee-for-service recipients in their district by implementing region-wide patient choice and value-based payment systems, along with capitation fees.

That assures that DCEs take on a full financial obligation with 100% shared savings and shared losses for Medicare Sections A and B services offered to recipients in a given region.

However, insurers will also be allowed to seize upon flexibilities that are unavailable to non-DCE Medicare providers, like over-the-counter prescription vouchers, meal plan privileges, among other beneficiary advantages. DCEs can also qualify for waivers with respect to the 3-Day Skilled Nursing Facility Rules, home visit regulations, and telehealth scope.

To read more, visit https://revcycleintelligence.com/news/cms-announces-a-new-value-based-direct-contracting-model.

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