STATEMENT OF INITIATIVE. The Centers for Medicare & Medicaid Services (CMS) and State of Illinois will establish a Federal-State partnership to implement the Medicare-Medicaid Alignment Initiative (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (Medicare- Medicaid Enrollees). The Federal-State partnership will include a Three-way Contract with Demonstration Plans that will provide integrated benefits to Medicare-Medicaid Enrollees in the targeted geographic areas. The Demonstration will begin on October 1, 2013, subject to the conditions described in this Memorandum of Understanding (MOU). It will continue until December 31, 2016, unless terminated pursuant to section L or extended pursuant to section K of this MOU. The initiative is testing an innovative payment and service delivery model to alleviate the fragmentation and improve coordination of services for Medicare-Medicaid Enrollees, enhance quality of care, and reduce costs for both the State and the Federal government. (See Appendix 1 for definitions of terms and acronyms used in this MOU.) This Demonstration is one in a series of the State’s initiatives to transform the health care environment in Illinois to one that is more person‐centered with a focus on improved health outcomes, enhanced beneficiary access, and beneficiary safety. State law requires moving 50% of all Medicaid beneficiaries from fee-for-service (FFS) to risk-based care coordination by January 2015. This Demonstration helps support the State’s health reform efforts by testing integration with Medicare. The population that will be eligible to participate in this Demonstration includes those beneficiaries who are entitled to benefits under Medicare Part A, enrolled under Medicare Parts B and D, and receive full Medicaid benefits, and meet the requirements discussed in more detail in Section C.1 below. Under this initiative, Demonstration Plans will be required to provide for, either directly or through subcontracts, Medicare and Medicaid-Covered Services under a capitated model of financing. CMS, the State, and the Demonstration Plans will ensure that beneficiaries have access to an adequate network of medical and supportive services. CMS and the State shall jointly select and monitor the Demonstration Plans. CMS will implement this initiative under demonstration authority for Medicare and demonstration, State Plan, and waiver authority for Medicaid as described in Section III.A and detailed in Appendices 4 and 5. Key o...
STATEMENT OF INITIATIVE. (SECTION I of the MOU) CMS and the State agree to begin this Managed Fee-for-Service Financial Alignment Demonstration on July 1, 2013, and continue until December 31, 2020, unless extended or terminated pursuant to the terms and conditions in Section V or VI, respectively, of this Agreement.
STATEMENT OF INITIATIVE. The Centers for Medicare & Medicaid Services (CMS) and the State of Ohio, Office of Medical Assistance (State/ Ohio Medicaid) will establish a Federal-State partnership to implement the Demonstration to Develop an Integrated Care Delivery System (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees” or “dual eligibles”). The Federal-State partnership will include a three-way contract with Integrated Care Delivery System (ICDS) Plans that will provide integrated benefits to Medicare-Medicaid Enrollees in the targeted geographic area(s). The Demonstration will begin on September 1, 2013 and continue until December 31, 2016, unless terminated pursuant to section L or continued pursuant to section K of this Memorandum of Understanding (MOU). The initiative is testing an innovative payment and service delivery model to alleviate the fragmentation and improve coordination of services for Medicare-Medicaid Enrollees, enhance quality of care and reduce costs for both the State and the Federal government. (See Appendix 1 for definitions of terms and acronyms used in this MOU.) The population that will be eligible to participate in the ICDS program is limited to "Full Benefit" Medicare-Medicaid Enrollees who are age 18 or older. Section C.1 below provides more information on individuals who are not eligible for the program as well as individuals who are eligible if they disenroll from an existing program. Under this initiative, ICDS Plans will be required to provide for, either directly or through subcontracts, Medicare and Medicaid-covered services, as well as additional items and services, under a capitated model of financing. CMS, the State, and the ICDS Plans will ensure that beneficiaries have access to an adequate network of medical and supportive services. CMS and the State shall jointly select and monitor the ICDS Plans. CMS will implement this initiative under Demonstration authority for Medicare and Demonstration or State Plan authority or waiver for Medicaid as described in section IIIA and detailed in Appendices 4 and 5. Key objectives of the initiative are to improve the beneficiary experience in accessing care, deliver person-centered care, promote independence in the community, improve quality, eliminate cost shifting between Medicare and Medicaid and achieve cost savings for the State and Federal government through improvements in care and coordination. CMS and the State expect this model ...
STATEMENT OF INITIATIVE. To establish a Federal-State partnership between the Centers for Medicare & Medicaid Services (CMS) and the State of Colorado (State), Department of Health Care Policy and Financing (Department), to implement the Colorado Demonstration to Integrate Care for Medicare-Medicaid Enrollees (Demonstration), a Managed Fee-for-Service (MFFS) Financial Alignment Model, to better serve individuals eligible for both Medicare and Medicaid (“enrollees” or “beneficiaries”). The Demonstration is intended to coordinate services across Medicare and Medicaid and achieve cost savings for the Federal and the State government through improvements in quality of care and reductions in unnecessary expenditures. CMS plans to begin this MFFS Financial Alignment Model Demonstration on July 1, 2014, and continue until December 31, 2017, unless terminated or extended pursuant to the terms and conditions of the Final Demonstration Agreement to be finalized before initiation of this Demonstration (see Appendix 1 for definitions of terms used in this MOU). Medicare-Medicaid enrollees’ needs and experiences, including the ability to self-direct care, be involved in one’s care, and live independently in the community, are central to this Demonstration. Key objectives of the Demonstration are to improve beneficiary experience in accessing care, promote person-centered planning, promote independence in the community, improve quality of care, assist beneficiaries in getting the right care at the right time and place, reduce health disparities, improve transitions among care settings, and achieve cost savings for the Federal and the State government through improvements in health and functional outcomes. Individuals eligible for this Demonstration are those meeting the following criteria: are enrolled in Medicare Parts A and B and eligible for Part D; receive full Medicaid benefits under Fee-for-Service (FFS) arrangements; have no other private or public health insurance; and are a resident of the State. Additional details are included in Section III.B below and in Appendix 3. Under this Demonstration, the State will be accountable for improving the coordination of care across existing providers and Medicare and Medicaid service delivery systems. In return, the State will be eligible to receive a retrospective performance payment based on its performance on quality and savings criteria as outlined later in this document in Section III.G and in Appendix 6. The primary objectives of this Demonst...
STATEMENT OF INITIATIVE. The Centers for Medicare & Medicaid Services (CMS) and the State of California (California) will establish a Federal-State partnership to implement the Demonstration to Integrate Care for Dual Eligible Individuals (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees” or “dual eligibles”). The Federal-State partnership will include a three-way contract with Demonstration Plans (“Prime Contractor Plans”) that will provide integrated benefits to Medicare-Medicaid enrollees in the targeted geographic area(s). The Demonstration will begin no sooner than October 1, 2013 and continue until December 31, 2016, unless terminated pursuant to section III.L or continued pursuant to section III.K of this Memorandum of Understanding (MOU). The initiative is testing an innovative payment and service delivery model to alleviate the fragmentation and improve coordination of services for Medicare-Medicaid enrollees, enhance quality of care and reduce costs for both the State and the Federal government. (See Appendix 1 for definitions of terms and acronyms used in this MOU.) The individuals that will be eligible to participate in the Demonstration are those who are entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits (known as Medi-Cal in California) and who have no other comprehensive private or public health insurance with some exceptions, as discussed in more detail in section
STATEMENT OF INITIATIVE. The Centers for Medicare & Medicaid Services (CMS) and the State of New York, Department of Health (State / NYSDOH) will establish a Federal-State partnership to implement a New York Integrated Appeals and Grievances Demonstration (hereinafter, the “Demonstration”) to streamline and simplify the grievance and appeals processes for individuals enrolled in both Medicare and Medicaid (“dually eligible individuals”). This Federal-State partnership will implement a Demonstration that integrates appeals and grievance processes for Medicaid Advantage Plus (“MAP”) plans and Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) with exclusively aligned enrollment participating in the MAP program sponsored by the same offeror (collectively, “the plans”). The Demonstration will begin January 1, 2020, and will continue until December 31, 2023 unless terminated earlier pursuant to section III.J or continued pursuant to section III.I of this Memorandum of Understanding. This Demonstration will include integrated plan-level grievance and appeals processes and a streamlined post-plan appeals process. This Demonstration is testing integrated grievance and appeals processes that will apply to all items and services covered by participating MAP plans and MAP-participating D-SNPs other than those provided under Medicare Part D. The integrated grievance and appeals process does not apply to: 1) Medicare and Medicaid items and services that are excluded from the plans’ benefit packages; and 2) Medicare Part D benefits. MAP plans and MAP-participating D-SNPs will apply the integrated grievance process described in 42 CFR § 422.630 to all plan-level grievances, whether relating to Medicare or to Medicaid. The plans will also apply the integrated coverage determination and reconsideration process described at 42 CFR § 422.629 and §§ 422.631 through 422.634. Any modifications to the grievance and plan-level appeals rules under 42 CFR §§ 422.629-422.634 will be consistent with the flexibilities available under those rules and are described in Appendix 3 to the MOU. For appeals subsequent to the plan level, a streamlined post-plan process will replace the separate Medicare and Medicaid processes. This process will ensure all procedural protections of both Medicare and Medicaid appeals processes. The specifics of this process are described in the Appendix 3 to this MOU. CMS and NYSDOH will provide oversight and monitoring of this integrated appeals process through an oversigh...
STATEMENT OF INITIATIVE. The Centers for Medicare & Medicaid Services (CMS), the State of New York, Department of Health (State / NYSDOH), and the State of New York Office for People with Developmental Disabilities (State / OPWDD) will establish a Federal-State partnership to implement the Medicare-Medicaid Alignment Initiative (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees”) who have intellectual and developmental disabilities (IDD). This Fully Integrated Duals Advantage Demonstration for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) shares the general goals and structure of the Fully Integrated Duals Advantage (FIDA) Demonstration, but the two demonstrations are distinct and involve different populations and Medicare-Medicaid Plans. Other important distinctions between the two demonstrations are that the FIDA-IDD Demonstration does not allow for passive enrollment of eligible individuals and includes a benefit package tailored to support individuals with IDD. As the Single State Medicaid Agency (SMA), NYSDOH is the lead State entity in this agreement and will delegate certain administrative and operational aspects of the Demonstration to OPWDD. The Federal-State partnership will include a Three-way Contract with one Medicare- Medicaid Plan (MMP) approved by CMS offering specialized networks and care management programs designed specifically to serve adults with IDD. This Fully Integrated Duals Advantage Plan for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD Plan) will provide integrated benefits to those Medicare-Medicaid Enrollees who reside in the targeted geographic area and who choose to participate in the Demonstration (Participants). The Demonstration will begin no earlier than April 1, 2016 and continue until December 31, 2020, unless terminated pursuant to section III.L or continued pursuant to section III.K of this Memorandum of Understanding (MOU). The initiative is testing an innovative payment and service delivery model to alleviate the fragmentation, improve coordination of services, and enhance quality of care for Medicare-Medicaid Enrollees with IDD, and reduce costs for both the State and the Federal government (see Appendix 1 for definitions of terms and acronyms used in this MOU). The population that will be eligible to participate in the FIDA-IDD Demonstration is limited to "Full Benefit" Medicare-Medicaid Enrollees who are age 21 or older an...
STATEMENT OF INITIATIVE. The Centers for Medicare & Medicaid Services (CMS) and the State of Washington (the Washington State Health Care Authority/Washington State Department of Social and Health Services) will establish a Federal-State partnership to implement HealthPathWashington: A Medicare-Medicaid Integration Demonstration to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees” or “beneficiaries”). The Federal-State partnership will include a Three-Way Contract with Medicare-Medicaid Integration Plans (MMIPs) that will provide integrated medical services, behavioral health services, and long-term services and supports to Medicare-Medicaid Enrollees in two geographic areas. The Demonstration will begin no earlier than July 1, 2014, and continue until December 31, 2017, unless terminated pursuant to Section III.L or continued pursuant to Section III.K of this Memorandum of Understanding (MOU). The initiative is testing an innovative payment and service delivery model to alleviate the fragmentation and improve coordination of services for Medicare-Medicaid Enrollees, enhance quality of care, and reduce costs for both the State and the Federal government. (See Appendix 1 for definitions of terms and acronyms used in this MOU.) This Demonstration will operate in two counties in the State – King County and Snohomish County. The population that will be eligible to participate in the Demonstration are those beneficiaries aged 21 and older who are entitled to benefits under Medicare Part A, and enrolled under Medicare Parts B and D, receive full Medicaid benefits, and meet the requirements discussed in more detail in Section C.1.1 below. This Capitated Demonstration will complement the State’s Managed Fee-for-Service Demonstration (which will be active in all counties of the State except King County and Snohomish County). Opportunities for better beneficiary outcomes, system efficiencies, and cost containment lie in the purchase of increasingly coordinated medical, mental health, chemical dependency, and long- term services and supports (LTSS). Fully financially integrated service delivery through health plans has the potential to yield long-term benefits through a single point of accountability over all services, greater flexibility to deliver person-centered services and supports, and aligned financial incentives. Under this initiative, MMIPs will be required to provide for, either directly or through subcontracts, Medicare and Medicaid co...
STATEMENT OF INITIATIVE. To establish a Federal-State partnership between the Centers for Medicare & Medicaid Services (CMS) and the State of Washington (the Washington State Health Authority/Washington State Department of Social & Health Services) to implement HealthPathWashington: A Medicare and Medicaid Integration Project, Managed Fee-for-Service Model (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid enrollees” or “beneficiaries”). The Federal-State partnership will provide the State with a new opportunity to establish a care management program for Medicare-Medicaid enrollees meeting high-cost/high- risk criteria that will coordinate services across Medicare and Medicaid, and allow the State and the Federal government to benefit from savings resulting from improvements in quality and reductions in costs. CMS plans to begin this Managed Fee-for-Service Financial Alignment Demonstration on April 1, 2013, and continue until December 31, 2016, unless terminated or extended pursuant to the terms and conditions of the Final Demonstration Agreement. The initiative is intended to alleviate fragmentation and improve coordination of services for high- cost, high-risk Medicare-Medicaid enrollees served primarily in fee-for-service systems of care. Improved coordination is intended to improve beneficiary outcomes and reduce overall costs over time for the State and the Federal government. (See Appendix 1 for definitions of terms and acronyms used in this MOU.) Beneficiary needs and experiences, including the ability to self-direct care, be involved in one’s care, and live independently in the community, are central to this Demonstration. Key objectives of the Demonstration are to improve beneficiary experience in accessing care, promote person- centered health action planning, promote independence in the community, improve quality of care, assist beneficiaries in getting the right care at the right time and place, reduce health disparities, improve transitions among care settings, and achieve cost savings for the State and the Federal government through improvements in health and functional outcomes. Individuals eligible for this Demonstration are those meeting the following criteria: are eligible for and enrolled in Medicare and receiving full Medicaid benefits under fee-for-service arrangements (excepting the provision of mental health services through Washington’s 1915(b) Federal authority); are eligible for Medicaid health home se...
STATEMENT OF INITIATIVE. The purpose of this Initiative is to establish a Federal-State partnership between the Centers for Medicare & Medicaid Services (CMS) and the State of Minnesota (State) to implement the Demonstration to Align Administrative Functions for Improvements in Beneficiary Experience (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (Medicare- Medicaid Enrollees or Beneficiaries). The Minnesota Senior Health Options program (MSHO) is one of the first integrated care initiatives for Medicare-Medicaid Beneficiaries, serving approximately 36,000 older adults through eight different health plans that contract with the State as Medicaid managed care organizations and with CMS as Medicare Advantage Special Needs Plans for Dual Eligibles (D-SNPs). Although the program has made great strides in integrating care for Medicare-Medicaid Beneficiaries, there are still many opportunities to more fully align Medicare and Medicaid within MSHO, to improve Beneficiary experiences and to address administrative efficiencies. (See Appendix 1 for definitions of terms and acronyms.) As a highly integrated program, MSHO has been successful in improving the Beneficiary experience by increasing access to care, delivering person-centered care, and promoting independence in the community. This Demonstration will further strengthen program integration and improve the Beneficiary experience by testing opportunities to better align existing Medicaid and Medicare Advantage managed care programs. To that end, the Demonstration is designed to enhance integration of services for Medicare-Medicaid Beneficiaries in new provider payment models, work to clarify and simplify information and processes for Beneficiaries and their families related to Medicare and Medicaid coverage, better align oversight of MSHO Plans by the State and CMS, and improve administrative efficiencies for the MSHO Plans and government agencies that serve MSHO Enrollees. Specifically, the Demonstration’s key objectives are: To enhance quality of care for Medicare-Medicaid Beneficiaries by improving coordination of services. To provide a more seamless experience for Medicare-Medicaid Beneficiaries, utilizing a simplified and unified set of program administration rules and materials. To allow CMS and the State to continue to work together to integrate Medicare and Medicaid policy and delivery of services, while operating within the context of the Medicare Advantage and Medicare Part D program...
