CICO Service Capacity. CMS and the State shall contract with CICOs that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to Enrollees, in accordance with this MOU, CMS guidance, and the Three-Way Contract. Medicare covered benefits shall be provided in accordance with 42 CFR §422 and 42 CFR §423 et seq. Medicaid covered benefits under the Demonstration shall be provided in accordance with 42 CFR §438 and with the requirements in the approved Medicaid State Plan, including any applicable State Plan Amendments and waiver authority discussed in Appendix 5, and in accordance with the requirements specified in this MOU. In accordance with the Three-Way Contract and this MOU, CMS and the State may choose to allow for greater flexibility in offering additional benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, the State, and CICOs will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and Long-Term Services and Supports (LTSS) providers that are appropriate and capable of addressing the needs of this diverse population, as discussed in more detail in Appendix 7. As further detailed in Appendix 7, the State will transition and phase in HCBS authority and accountability over the course of the Demonstration. During Phase I of the Demonstration, the State will maintain contractual relationships with HCBS providers. CICOs, however, will receive payment for these services and process provider payments through Care Call. For Phase II, CICOs that have successfully completed the first HCBS benchmark review will assume responsibility for case management (CM) services and most HCBS, in addition to the full continuum of Medicare and Medicaid covered services they are already providing. For Phase III, CICOs that have successfully completed the final HCBS benchmark review will provide all CM and HCBS and assume responsibility for the full continuum of care under this Demonstration. Additional details regarding the Phase-In, including the roles and responsibilities of CMS/State and the CICOs, is contained in Appendix 7.
