Shenango Valley News

WASHINGTON, D.C. -- Today, U.S. Representatives Mike Kelly (R-PA) and Ami Bera, M.D. (D-CA) introduced the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 to improve coverage for individuals jointly enrolled in Medicare and Medicaid, also known as dual eligibles.

Similar legislation has been introduced in the U.S. Senate by Senators Bill Cassidy, M.D. (R-LA), Tom Carper (D-DE), John Cornyn (R-TX), Mark Warner (D-VA), Tim Scott (R-SC), and Bob Menendez (D-NJ), members of the Senate Duals Working Group.

"We are always striving to find the best way possible to serve patient needs, improve patient outcomes, and ultimately strengthen Medicare and Medicaid programs," said Representative Mike Kelly, a member of the Ways & Means Subcommittee on Health. "This legislation will improve coverage for Americans enrolled in both programs and will ultimately save taxpayer money."

“Patients who are dually eligible for Medicare and Medicaid should not face poor health outcomes due to the bureaucratic patchwork of our health care system,” said Representative Ami Bera, M.D., who previously served as Chief Medical Officer for Sacramento. “This bill takes a critical step forward in ensuring that some of the most vulnerable Americans receive the integrated and quality care that they deserve. I am proud to stand with my colleagues in Congress in supporting these bipartisan efforts that prioritize the well-being of millions of Americans while saving taxpayers money.”

The DUALS Act of 2024 requires each state, with support from the Centers for Medicare & Medicaid Services (CMS), to select, develop, and implement a comprehensive, integrated health plan for dual-eligible beneficiaries. States can create a new system or build off existing coverage options.

The act aims to improve beneficiary experience by requiring plans to develop and update care coordination plans, establishing ombudsman offices, and assigning a care coordinator for each beneficiary.

To reduce beneficiary confusion, it proposes reducing “look-alike” plans which target dual eligible beneficiaries without providing any coordination; creating a single appeals process instead of separate Medicare and Medicaid appeals processes; and reducing third-party marketing organization incentives targeting beneficiaries.

Additionally, it expands Program of All-Inclusive Care for the Elderly (PACE) coverage nationwide by requiring every state to allow PACE programs' establishment; permitting enrollment in PACE programs at any time during the month; and extending PACE coverage to individuals under age 55.

The DUALS Act of 2024 is supported by Centerlight Healthcare, Santa Clara Family Health Plan, Association for Community Affiliated Plans (ACAP), PointClickCare, Welbe Health, American Kidney Fund, National Multiple Sclerosis Society, Alliance of Community Health Plans, LeadingAge, Bipartisan Policy Center National Health Council ChristianaCare DaVita National Pace Association.

Approximately 12.2 million low-income or disabled people in the United States are jointly enrolled in Medicare and Medicaid. Dual eligibles represent a diverse group with complex needs including multiple chronic conditions physical disabilities mental illness cognitive impairments such as dementia developmental disabilities among others who are relatively healthy.

While representing a small proportion of Medicare and Medicaid beneficiaries dual eligibles account for a disproportionate share of overall spending In Medicare program 19% enrollees are dually eligible but account for 34% spending Similarly 14% Medicaid enrollees are dually eligible but constitute 30% overall spending In 2019 combined Medicare Medicaid spending on dual eligibles rose total $4402 billion

The COVID-19 pandemic further exposed need reforms systems care dual eligibles According federal data across every demographic group dual eligibles were more likely contract COVID-19 More concerning dual eligibles were more than three times likely hospitalized from COVID-19 compared Medicare only individuals