Section 2602 of the Affordable Care Act

The Federal Coordinated Health Care Office

(“Medicare-Medicaid Coordination Office”)

Public Law 111–148 (42 U.S.C. 1315 b(d)) created the Federal Coordinated Health Care Office,

commonly known as the Medicare-Medicaid Coordination Office, or MMCO. The Bipartisan Budget

Act of 2018 added new responsibilities for the office. The full statutory text follows, as of June 2019.

42 U.S.C. 1315 b(d) PROVIDING FEDERAL COVERAGE AND PAYMENT COORDINATION

FOR DUAL ELIGIBLE BENEFICIARIES.

(a) Establishment of Federal Coordinated Health Care Office-

(1) IN GENERAL- Not later than March 1, 2010, the Secretary of Health and

Human Services (in this section referred to as the ‘Secretary’) shall establish a

Federal Coordinated Health Care Office.

(2) ESTABLISHMENT AND REPORTING TO CMS ADMINISTRATOR- The

Federal Coordinated Health Care Office--

(A) shall be established within the Centers for Medicare & Medicaid

Services; and

(B) have as the Office a Director who shall be appointed by, and be in

direct line of authority to, the Administrator of the Centers for Medicare &

Medicaid Services.

(b) Purpose- The purpose of the Federal Coordinated Health Care Office is to bring

together officers and employees of the Medicare and Medicaid programs at the Centers

for Medicare & Medicaid Services in order to--

(1) more effectively integrate benefits under the Medicare program under title XVIII

of the Social Security Act and the Medicaid program under title XIX of such Act; and

(2) improve the coordination between the Federal Government and States for

individuals eligible for benefits under both such programs in order to ensure that

such individuals get full access to the items and services to which they are entitled

under titles XVIII and XIX of the Social Security Act.

(1) Providing dual eligible individuals full access to the benefits to which such

individuals are entitled under the Medicare and Medicaid programs.

(2) Simplifying the processes for dual eligible individuals to access the items and

services they are entitled to under the Medicare and Medicaid programs.

(3) Improving the quality of health care and long-term services for dual eligible

individuals.

(4) Increasing dual eligible individuals' understanding of and satisfaction

with coverage under the Medicare and Medicaid programs.

(5) Eliminating regulatory conflicts between rules under the Medicare and Medicaid

programs.

(6) Improving care continuity and ensuring safe and effective care transitions

for dual eligible individuals.

(7) Eliminating cost-shifting between the Medicare and Medicaid program

and among related health care providers.

(8) Improving the quality of performance of providers of services and

suppliers under the Medicare and Medicaid programs.

(d) Specific Responsibilities- The specific responsibilities of the Federal

Coordinated Health Care Office are as follows:

(1) Providing States, specialized MA plans for special needs individuals (as

defined in section 1859(b)(6) of the Social Security Act (42 U.S.C. 1395w-

28(b)(6))), physicians and other relevant entities or individuals with the

education and tools necessary for developing programs that align benefits

under the Medicare and Medicaid programs for dual eligible individuals.

(2) Supporting State efforts to coordinate and align acute care and long-term

care services for dual eligible individuals with other items and services furnished

under the Medicare program.

(3) Providing support for coordination of contracting and oversight by States and

the Centers for Medicare & Medicaid Services with respect to the integration of

the Medicare and Medicaid programs in a manner that is supportive of the goals

described in paragraph (3).

(4) To consult and coordinate with the Medicare Payment Advisory Commission

established under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) and

the Medicaid and CHIP Payment and Access Commission established under

section 1900 of such Act (42 U.S.C. 1396) with respect to policies relating to the

enrollment in, and provision of, benefits to dual eligible individuals under the

Medicare program under title XVIII of the Social Security Act and the Medicaid

program under title XIX of such Act.

(5) To study the provision of drug coverage for new full-benefit dual eligible

individuals (as defined in section 1935(c)(6) of the Social Security Act (42 U.S.C.

1396u-5(c)(6)), as well as to monitor and report annual total expenditures, health

outcomes, and access to benefits for all dual eligible individuals.

(6) To act as a designated contact for States under sub- section (f)(8)(A) of

section 1859 of the Social Security Act (42 U.S.C. 1395w–28) with respect to

the integration of specialized MA plans for special needs individuals described

in subsection (b)(6)(B)(ii) of such section.

(7) To be responsible, subject to the final approval of the Secretary, for

developing regulations and guidance related to the implementation of a unified

grievance and appeals process as described in subparagraphs (B) and (C) of

section 1859(f)(8) of the Social Security Act (42 U.S.C. 1395w–28(f)(8)).

(8) To be responsible, subject to the final approval of the Secretary, for

developing regulations and guidance related to the integration or alignment of

policy and oversight under the Medicare program under title XVIII of such Act

and the Medicaid program under title XIX of such Act regarding specialized MA

plans for special needs individuals described in sub- section (b)(6)(B)(ii) of such

section 1859.

(e) Report- The Secretary shall, as part of the budget transmitted under section

1105(a) of title 31, United States Code, submit to Congress an annual report

containing recommendations for legislation that would improve care coordination and

benefits for dual eligible individuals.

(f) Dual Eligible Defined- In this section, the term `dual eligible individual' means an

individual who is entitled to, or enrolled for, benefits under part A of title XVIII of the Social

Security Act, or enrolled for benefits under part B of title XVIII of such Act, and is eligible

for medical assistance under a State plan under title XIX of such Act or under a waiver of

such plan.