Duals: A Sneak Peek

Spring 2016


Neighborhood remains on track in its thorough preparations to offer a health care plan tailored to the “duals” population – those members who are eligible for both Medicaid and Medicare services. In January, we welcomed a site visit from the Centers for Medicare and Medicaid’s NORC team, who came to assess our readiness to offer services to this new population. We are proud to announce that their detailed investigation resulted in an official report finding zero deficiencies,  clearing the way for us to continue in our preparations. The reviewers were especially impressed with Neighborhood’s care management, our robust compliance process and our relationships with the state’s community health centers.

We are currently in the process of hosting more site visits from the Rhode Island Executive Office of Health and Human Services. Their first visit focused on our front-line staff in care management as well as on our nursing home transition teams. The state will conduct additional reviews with other departments, including member services and claims.
As this review process continues, we await our first effective enrollment date for the new duals plan, currently anticipated to roll out no sooner than July 1, 2016.