Landmark legislation, the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024, was introduced on March 14 by Senator Bill Cassidy (R-LA) and a bipartisan group of five members of the Senate Finance Committee (Senators Tom Carper (D-DE), John Cornyn (R-TX), Bob Menendez (D-NJ), Tim Scott (R-SC), and Mark Warner (D- VA) ).

The bill, which includes many of the recommendations included in our 2017 white paper, Integrated Service Delivery: A LeadingAge Vision for America’s Aging Population, would establish a new title of the Social Security Act creating a State Integrated Care Programs for Dual Eligible individuals recognizing the need to streamline and coordinate care and services for America’s more than 12 million dual eligibles — people who are eligible for both Medicare and Medicaid.

Key recommendations from the white paper included by the bill’s authors, who worked with stakeholders for more than a year on the new program’s design, are:

• A single care coordinator assigned to each beneficiary;
• A standardized health risk assessment used to identify the comprehensive needs of the individual;
• The development of a comprehensive care plan that encompasses the individual’s medical, functional, behavioral, social and caregiving needs and goals, and is delivered by an interdisciplinary care team;
• A single pooled payment to the integrated care plan that brings together Medicare and Medicaid contributions.

In a March 14 press conference, the bill’s senate sponsors noted that they received input from 125 stakeholder groups to craft the final legislation. Given our contributions to the legislation, LeadingAge offered its support March 14 for the legislation in a letter to the bill’s authors.

LeadingAge President and CEO Katie Smith Sloan lauded the bill saying  in a press release that “The DUALS Act of 2024 addresses some of the challenges and opportunities facing America as our population ages. For too many older adults, particularly those with low incomes and multiple, chronic health conditions, accessing care and services through Medicare and Medicaid is a fraught endeavor that ends in frustration and – worse yet – inadequate results. This legislation is a start at redesigning our current patchwork approach of delivering long-term services and supports.”

Under the legislation, each state would be required, with help from the Centers for Medicare and Medicaid Services (CMS) to select, develop and implement a comprehensive, integrated health plan for dual eligible individuals in their states. This would place the new program on even footing with both the Medicare and Medicaid programs. The objective is to ensure that individuals dually eligible for both Medicare and Medicaid have access to an integrated set of services, providers, rules and payment that would ease navigation in addressing their health care and social needs, and improve outcomes. The Act would also preserve and expand the Program for All-Inclusive Care for the Elderly by requiring every state to allow PACE programs to be established, allowing enrollment at any time during the month and expanding access to these programs to individuals 55 years and older.

Other features include:

• Duals would be auto-enrolled into an available integrated care plan (ICP) that includes the individual’s existing primary care practitioner as an in-network provider and the dual could make an alternate selection within 60 days. Duals also would retain the right to change integrated care plans monthly.
• A requirement that ICPs conduct a standardized health risk assessment for each dual eligible, at least annually, and develop a corresponding, comprehensive care plan with the person’s interdisciplinary team.
• Assigning each dual eligible a single care coordinator responsible for helping them and their caregivers to navigate benefits and services.
• A single per member per month amount paid to the ICP to cover all medical, functional, behavioral, social and caregiving needs for the dual eligible.
• Establishing an ombudsman for dual eligibles.
• Limiting enrollment assistance to independent brokers to help dual eligibles select an ICP and paying the broker a one-time payment instead of a commission every time a dual eligible switches plans.
• Developing an aligned program for Institutional Special Needs Plans to be financially responsible for providing integrated services to dual eligibles enrolled in their plan.
• Making it more difficult for Medicare Advantage plans to market plans that look like dual eligible plans.

Sen. Carper at the press conference said he intends to reach out to members of the House Energy & Commerce Committee, specifically mentioning Congresswoman Lisa Blunt Rochester (D-DE), to foster House support for the legislation. On the Senate side, Sen. Carper said that the chair and ranking member of the Senate Finance Committee had been briefed on the bill and while no hearing is currently scheduled, the committee leaders had expressed interest in the legislation.