Senator Scott, Colleagues Introduce Landmark Legislation Strengthening American Healthcare

WASHINGTON — In his role as a member of the Senate Duals Working Group, U.S. Senator Tim Scott (R-S.C.) joined Senate Health, Education, Labor and Pensions (HELP) Committee Ranking Member Bill Cassidy, M.D. (R-La.) and Senators Tom Carper (D-Del.), John Cornyn (R-Texas), Mark Warner (D-Va.), and Bob Menendez (D-N.J.) in introducing legislation to improve healthcare options for the approximately 12 million Americans jointly enrolled in Medicare and Medicaid—also known as dual eligibles. The Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 addresses the fragmented, inefficient connections between Medicare and Medicaid, and ensures that dual eligibles gain streamlined access to high-quality healthcare.

“Many states lack fully integrated care between Medicare and Medicaid, leaving dually eligible individuals with fragmented care and the headaches of confusing bureaucracy. We can, and must, do better for this vulnerable population,” said Senator Scott. “Our bill will help ensure these programs work together so that patients across the nation can access the high quality care they deserve.”

This legislation follows two years of data collection and feedback by Senator Scott and the Senate Duals Working Group from the healthcare community. The lawmakers heard from healthcare providers and patients regarding shortfalls in the current system of care for dual eligibles, how to improve patient health outcomes, and the role of federal or state governments in dual eligibles’ care.

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, and National Pace Association.

The DUALS Act of 2024

  • Recognizes that while representing a small proportion of Medicare and Medicaid beneficiaries, dual eligibles account for a disproportionate share of overall spending. In the Medicare program, 19% of enrollees are dually eligible but account for 34% of spending. Similarly, 14% of Medicaid enrollees are dually eligible but constitute 30% of overall spending;
  • 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 of existing coverage options;
  • Improves beneficiary experience by requiring plans to develop and update care coordination plans, requiring the establishment of ombudsman offices, and establishing a care coordinator for each beneficiary;
  • Reduces beneficiary confusion by reducing “look-alike” plans – which target dual eligible beneficiaries for enrollment, but don’t provide any coordination – creates a single appeals process instead of the current Medicare and Medicaid appeals process, and reduces third-party marketing organization incentives to target beneficiaries;
  • Expands Program of All-Inclusive Care for the Elderly (PACE) coverage nationwide by requiring every state to allow PACE programs to be established, allows enrollment in a PACE program at any time in the month, and expands PACE coverage to individuals under the age of 55; and
  • Acknowledges dual eligibles are a diverse group with complex needs, including individuals with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities.