$80.00 $80.00 Medicare Medicare Payment Payment Medicare only Dual in FFS Dual in One Demo 2.0: (non-duals) Care/ SCO Dual in One Care/SCO Example Medicaid Wrap Limit in One Care/SCO: 97.5-100% of Medicare allowable Contingent upon CMS approval Slide 18 Illustrative example of potential limits on Medicaid wrap payments in One Care and SCO: Professional Services ILLUSTRATIVE EXAMPLE Non-Dual Dual Member (Medicare + Medicaid) Provider (Medicare Payments Only) Provider Payments In FFS, One Care and Limits on the providers SCO plans have Medicaid wrap receive less historically paid portion of than the total providers the provider Medicare full Medicare payments in payment allowable One Care and allowable, as amount (more SCO could Medicaid wrap in some cases) reduce the is less than the amount One traditional Care and SCO patient co-pay plans pay
$80.00 Medicare Payment $80.00 Medicare Payment Medicare only (non-duals) Dual in FFS Dual in One Care/ SCO Demo 2.0: Dual in One Care/SCO Example Medicaid Wrap Limit in One Care/SCO: 97.5-100% of Medicare allowable Contingent upon CMS approval Slide 18 Illustrative example of potential limits on Medicaid wrap payments in One Care and SCO: Professional Services ILLUSTRATIVE EXAMPLE Non-Dual (Medicare Only) Provider Payments Dual Member (Medicare + Medicaid) Provider Payments In FFS, providers receive less than the total Medicare payment allowable, as Medicaid wrap is less than the traditional patient co-pay One Care and SCO plans have historically paid providers the full Medicare allowable amount (more in some cases) Limits on the Medicaid wrap portion of provider payments in One Care and SCO could reduce the amount One Care and SCO plans pay