CMS to Allow Managed Care Organizations to Participate in Direct Contracting

CMS laid out some examples of how an MCO could use the voluntary direct contracting model, including:

• Entering into value-based purchasing agreements with nursing facilities that factor in facility hospitalization rates
• Establishing processes to connect beneficiaries with a primary care provider
• Targeting care coordination resources toward beneficiaries that have a high risk of Medicare spending
• Having care coordinators and in-home aides that provide Medicaid long-term services to help enrollees with managing medical appointments.

Any MCO that participates in direct contracting needs to get a letter of support from their state Medicaid agency to ensure participation aligns with any state-managed plans.