Common use of STATEMENT OF INITIATIVE Clause in Contracts

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 of integrated care and financing to, among other things, improve quality of care and reduce health disparities, meet both health and functional needs, and improve transitions among care settings. Meeting beneficiary needs, including the ability to self-direct care, be involved in one’s care, and live independently in the community, are central goals of this initiative. CMS and the State expect ICDS Plans and provider implementation of the independent living and recovery philosophy, wellness principles, and cultural competence to contribute to achieving these goals. The initiative will test the effect of an integrated care and payment model on serving both community and institutional populations. In order to accomplish these objectives, comprehensive contract requirements will specify access, quality, network, financial solvency, and oversight standards. Contract management will focus on performance measurement and continuous quality improvement. Except as otherwise specified in this MOU, ICDS Plans will be required to comply with all applicable existing Medicare and Medicaid laws, rules, and regulations as well as program specific and evaluation requirements, as will be further specified in a three-way contract to be executed among the ICDS Plans, the State, and CMS. As part of this initiative, CMS and the State will test a new Medicare and Medicaid payment methodology designed to support ICDS Plans in serving Medicare-Medicaid Enrollees in the Demonstration. This financing approach will minimize cost-shifting, align incentives between Medicare and Medicaid, and support the best possible health and functional outcomes for Enrollees. CMS and the State will allow for certain flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid Enrollees, utilizing a simplified and unified set of rules, as detailed in the sections below. Flexibilities will be coupled with specific beneficiary safeguards and will be included in this MOU and the three-way contract. ICDS Plans will have full accountability for managing the capitated payment to best meet the needs of Enrollees according to Individualized Care Plans developed by Enrollees, their caregivers, and Trans- disciplinary Care Management Teams using a person-centered planning process. CMS and the State expect ICDS Plans to achieve savings through better integrated and coordinated care. Subject to CMS and State oversight, ICDS Plans will have significant flexibility to innovate around care delivery and to provide a range of community-based services as alternatives to or means to avoid high-cost services if indicated by the Enrollees’ wishes, needs, and Individualized Care Plan. Preceding the signing of this MOU, the State has undergone necessary planning activities consistent with the CMS standards and conditions for participation, as detailed through supporting documentation provided in Appendix 2. This includes a robust beneficiary- and stakeholder- engagement process.

STATEMENT OF INITIATIVE. ‌ The Centers for Medicare & Medicaid Services (CMS) and the State of Ohio, Rhode Island (RI) Executive Office of Medical Assistance Health and Human Services (State/ Ohio MedicaidEOHHS) will establish a Federal-State partnership to implement the Demonstration to Develop an Medicare-Medicaid Alignment Integrated Care Delivery System Initiative Demonstration (“ICI Demonstration” or “Demonstration”) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees” or “dual eligiblesBeneficiaries”). The Federal-State partnership will include a threeThree-way contract with Integrated Care Delivery System Contract between CMS, the State, and one or more Medicare-Medicaid Plans (ICDSMMPs) Plans that will provide integrated benefits to Medicare-those Medicare- Medicaid Enrollees Beneficiaries who reside in the targeted geographic area(s) and who choose to participate (Enrollees). The Demonstration will begin on September no sooner than December 1, 2013 2015 and continue until December 31, 20162018, unless terminated pursuant to section Section L or continued pursuant to section Section K of this Memorandum of Understanding (MOU). The initiative is testing Meeting Enrollee needs, including the ability to self- direct care and perform self-care, and live independently in the community, are central goals of this Demonstration. In meeting such needs, the ICI Demonstration will seek to test an innovative payment and service delivery model to alleviate the fragmentation and fragmentation; improve coordination of services for Medicare-Medicaid Enrollees, Beneficiaries; enhance quality of care and care; reduce costs for both the State and the Federal government; meet Enrollees’ health and functional needs; improve transitions among care settings; and reduce health disparities. CMS and the State expect MMP and provider implementation of the independent living and recovery philosophy, wellness principles, and cultural competence to contribute to achieving these goals. (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 one or more MMPs will be required to provide for, either directly or through subcontracts, Medicare 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 MMPs will ensure that beneficiaries Enrollees have access to an adequate network of medical and supportive services. The ICI Demonstration will be implemented as part of the State’s broader Integrated Care Initiative, which aims to achieve improved health and well-being, and better health care, at lower costs for a segment of Rhode Island’s Medicaid-only and Medicare-Medicaid Beneficiaries. In 2013, under Phase I of the Integrated Care Initiative, the State introduced an enhanced Primary Care Case Management model called Connect Care Choice Community Partners (CCCCP) and a Medicaid health plan model called the Rhody Health Options (RHO) program, available to Medicaid-only and Medicare-Medicaid Beneficiaries under the Rhode Island Comprehensive Section 1115(a) demonstration. The one health plan participating in the RHO program is also the only current prospective MMP for the ICI Demonstration. The ICI Demonstration is part of Phase II of the Integrated Care Initiative, and will require at least one MMP to provide both Medicare and Medicaid benefits to ICI Demonstration Enrollees, with the exception of certain developmental disability and other services (outlined in Appendix 7) that are also carved out of Phase I. These services will continue to be provided to ICI Demonstration Enrollees via the fee-for-service (FFS) system and will not be covered by the capitated rate. The individuals who receive those services will be eligible for Demonstration enrollment. CMS and the State may seek to bring these services into the ICI Demonstration in the future. Medicare-Medicaid Beneficiaries will have the choice to opt out of the ICI Demonstration. For Medicaid benefits, individuals who opt out of the ICI Demonstration may enroll in or remain in RHO or any other Medicaid program that may be available to Medicare-Medicaid Beneficiaries for Medicaid services only. For Medicare benefits, individuals who opt out of the ICI Demonstration will have the choice to enroll in a Medicare Advantage plan, or receive FFS Medicare and enroll in a Prescription Drug Plan (PDP). Medicare-Medicaid Beneficiaries eligible for the ICI Demonstration may also be eligible to enroll in the Program of All-Inclusive Care for the Elderly (PACE), if they choose not to enroll in the Demonstration. Outreach and enrollment notices for the ICI Demonstration will inform Medicare-Medicaid Beneficiaries of all enrollment options. CMS and the State shall jointly select and monitor the ICDS PlansMMPs. CMS and the State will implement this initiative the ICI Demonstration under Demonstration Medicare Parts C and D and demonstration authority for Medicare Medicare, and Demonstration or State Plan and Rhode Island Comprehensive Section 1115(a) demonstration authority or waiver for Medicaid Medicaid, as described in section IIIA Section III.A and detailed in Appendices 4 and 5. Key objectives Consistent with the goals of the initiative are to improve State’s Comprehensive Section 1115(a) demonstration and the beneficiary experience in accessing careIntegrated Care Initiative, deliver key goals of the ICI Demonstration include: • Enhancing person-centered care, promote independence in the community, improve quality, eliminate cost shifting between Medicare ; • Improving and Medicaid maintaining Enrollee quality of life and achieve cost savings for the State and Federal government through improvements in care and coordination. CMS and the State expect this model of care; • Developing an integrated care and financing to, among other things, improve quality system of care and reduce health disparities, meet both health and functional needs, and improve transitions among coordination of services; • Increasing the proportion of individuals successfully residing in a community setting; • Reducing long-term care settings. Meeting beneficiary needs, including the ability to selfcosts by providing person-direct care, be involved in one’s care, and live independently centered care in the communitymost appropriate and cost-effective setting; • Decreasing avoidable hospitalizations, are central goals emergency room utilization and reducing nursing facility admissions and length of this initiative. CMS and the State expect ICDS Plans and provider implementation of the independent living and recovery philosophy, wellness principles, and cultural competence to contribute to achieving these goals. The initiative will test stay; • Evaluating the effect of an integrated care and payment model on serving Medicare-Medicaid Beneficiaries who receive care and supports in the community and in institutions; and • Promoting Alternative Payment Arrangements as a means to transform the delivery of high quality and cost-effective care within CMS requirements. The Demonstration will evaluate the effect of an integrated care and payment model on both community community-based and institutional populations. In order to accomplish these objectives, comprehensive contract requirements will specify access, quality, network, financial solvency, and oversight standardsstandards as well as requirements. Contract management management, which will be jointly accomplished by the State and CMS, will focus on performance measurement and continuous quality improvement. Except as otherwise specified in this MOU, ICDS Plans applicable Medicaid waiver or Section 1115(a) demonstration standards and conditions, State Plan Amendments, or the Three- way Contract, MMPs will be required to comply with all applicable existing Medicare and Medicaid laws, rules, and regulations as well as program ICI Demonstration-specific and evaluation requirements, as will be further specified in a threethe Three-way contract Contract to be executed among the ICDS Planseach MMP, the State, and CMS. As part of this initiativeDemonstration, CMS and the State will test implement a new Medicare and Medicaid payment methodology designed to support ICDS Plans MMPs in serving Medicare-Medicaid Enrollees Beneficiaries enrolled in the Demonstration, and will further encourage MMPs to utilize Alternative Payment Arrangements to support delivery system transformation. This financing approach will minimize cost-shifting, align incentives between Medicare and Medicaid, and support the best possible health and functional outcomes for Enrollees. CMS and the State will allow for certain flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid EnrolleesBeneficiaries, utilizing a simplified and unified set of rules, as detailed in the sections belowrules where feasible. Flexibilities will be coupled with specific beneficiary Enrollee safeguards and will be included in this MOU and the threeThree-way contractContract. ICDS Plans MMPs will have full accountability for managing the capitated payment to best meet the needs of Enrollees according to Individualized Enrollees. Interdisciplinary Care Plans for Enrollees eligible for Long-term Services and Supports (LTSS) or otherwise determined to be high-risk will be developed by Enrollees, their caregivers, and Trans- disciplinary Interdisciplinary Care Management Teams Team, using a person-centered planning process. CMS and the State expect ICDS Plans MMPs to achieve savings through better integrated and coordinated care. Subject to CMS and State oversight, ICDS Plans MMPs will have significant flexibility to innovate around care delivery and to provide a range of community-based services as alternatives to or means to avoid high-cost services if indicated by the Enrollees’ wishes, needs, and Individualized Interdisciplinary Care Plan. Preceding the signing of this MOU, the State has undergone necessary planning activities consistent with the CMS standards and conditions for participation, as detailed through supporting documentation provided in Appendix 2. This includes a robust beneficiary- and stakeholder- engagement process.

STATEMENT OF INITIATIVE. ‌ The Centers for Medicare & Medicaid Services (CMS) and the State of OhioNew York, Office Department of Medical Assistance Health (State/ Ohio MedicaidState / NYSDOH) will establish a Federal-State partnership to implement the Demonstration to Develop an Integrated Care Delivery System Medicare-Medicaid Alignment Initiative (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees” or “dual eligibles”). The Federal-State partnership will include a threeThree-way contract Contract with Fully Integrated Care Delivery System Duals Advantage (ICDSFIDA) Plans, which are Medicare-Medicaid Plans (MMPs) that will provide integrated benefits to Medicare-those Medicare- Medicaid Enrollees who reside in the targeted geographic area(sarea and who choose to participate in the Demonstration (Participants). The Demonstration will begin on September no earlier than July 1, 2013 2014 and continue until December 31, 20162017, unless terminated pursuant to section L III.L or continued pursuant to section K 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 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 FIDA Demonstration is limited to "Full Benefit" Medicare-Medicaid Enrollees who are age 18 21 or olderolder and meet the eligibility criteria outlined herein. Section C.1 III.C.1 below provides more information on individuals who are not eligible for the program FIDA Demonstration as well as individuals who are eligible if they disenroll from an existing program. Under this initiative, ICDS FIDA 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 FIDA Plans will ensure that beneficiaries Participants have access to an adequate network of medical and supportive services. CMS and the State shall jointly select and monitor the ICDS FIDA Plans. CMS will implement this initiative under Demonstration authority for Medicare and Demonstration or State Plan authority or waiver for Medicaid as As described in section IIIA III.A and detailed in Appendices 4 and 5, CMS will implement this initiative under Medicare Parts C and D and demonstration authority for Medicare and State Plan, demonstration, and waiver authority for Medicaid. Key objectives of the initiative are to improve the beneficiary Participant experience in accessing care, deliver person-centered care, promote independence in the community, improve quality, eliminate cost shifting between Medicare and Medicaid Medicaid, and achieve cost savings for the State and Federal government through improvements in care and coordination. CMS and the State expect this model of integrated care and financing to, among other things, improve quality of care and reduce health disparities, meet both health and functional needs, and improve transitions among care settings. Meeting beneficiary Participant needs, including the ability to self-direct care, be involved in one’s care, and live independently in the community, are central goals of this initiative. CMS and the State expect ICDS Plans FIDA Plan and provider implementation of the independent living and recovery philosophy, wellness principles, and cultural competence to contribute to achieving these goals. The initiative will test the effect of an integrated care and payment model on serving both community and institutional populations. In order to accomplish these objectives, comprehensive contract requirements will specify access, quality, network, financial solvency, and oversight standards. Contract management will focus on performance measurement and continuous quality improvement. Except as otherwise specified in this MOU, ICDS FIDA Plans will be required to comply with all applicable existing Medicare and Medicaid laws, rules, and regulations as well as program specific and evaluation requirements, except as modified by this MOU. This will be further specified in a threeThree-way contract Contract to be executed among the ICDS FIDA Plans, the State, and CMS. As part of this initiative, CMS and the State will test a new Medicare and Medicaid payment methodology designed to support ICDS FIDA Plans in serving Medicare-Medicaid Enrollees in the Demonstration. This financing approach will minimize cost-shifting, align incentives between Medicare and Medicaid, and support the best possible health and functional outcomes for EnrolleesParticipants. CMS and the State will allow for certain flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid Enrollees, utilizing a simplified and unified set of rules, as detailed in the sections below. Flexibilities will be coupled with specific beneficiary Participant safeguards and will be included in this MOU and the threeThree-way contractContract. ICDS FIDA Plans will have full accountability for managing the capitated payment to best meet the needs of Enrollees according to Individualized Care Participants. Person-Centered Service Plans will be developed by EnrolleesParticipants, their caregivers, and Trans- disciplinary Care Management Teams Interdisciplinary Team, using a person-person- centered planning process. CMS and the State expect ICDS FIDA Plans to achieve savings through better integrated and coordinated care. Subject to CMS and State oversight, ICDS FIDA Plans will have significant flexibility to innovate around care delivery and to provide a range of community-based services as alternatives to or means to avoid high-cost services if indicated by the EnrolleesParticipants’ wishes, needs, and Individualized Care Person-Centered Service Plan. Preceding the signing of this MOU, the State has undergone necessary planning activities consistent with the CMS standards and conditions for participation, as detailed through supporting documentation provided in Appendix 2. This includes a robust beneficiary- Participant- and stakeholder- engagement process.

STATEMENT OF INITIATIVE. ‌ The Centers for Medicare & Medicaid Services (CMS) ), the State of New York, Department of Health (State / NYSDOH), and the State of Ohio, New York Office of Medical Assistance for People with Developmental Disabilities (State/ Ohio MedicaidState / OPWDD) will establish a Federal-State partnership to implement the Demonstration to Develop an Integrated Care Delivery System Medicare-Medicaid Alignment Initiative (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees” or “dual eligibles”) 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 threeThree-way contract 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 Care Delivery System Duals Advantage Plan for Individuals with Intellectual and Developmental Disabilities (ICDSFIDA-IDD Plan) Plans that will provide integrated benefits to those Medicare-Medicaid Enrollees who reside in the targeted geographic area(sarea and who choose to participate in the Demonstration (Participants). The Demonstration will begin on September no earlier than April 1, 2013 2016 and continue until December 31, 20162020, unless terminated pursuant to section L III.L or continued pursuant to section K III.K of this Memorandum of Understanding (MOU). The initiative is testing an innovative payment and service delivery model to alleviate the fragmentation and fragmentation, improve coordination of services services, and enhance quality of care for Medicare-Medicaid EnrolleesEnrollees with IDD, enhance quality of care and reduce costs for both the State and the Federal government. government (See 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 FIDA-IDD Demonstration is limited to "Full Benefit" Medicare-Medicaid Enrollees who are age 18 21 or olderolder and meet the eligibility criteria outlined herein. Section C.1 III.C.1 below provides more information on individuals who are not eligible for the program FIDA-IDD Demonstration as well as individuals who are eligible if they disenroll from an existing program. Under this initiative, ICDS Plans the FIDA-IDD Plan will be required to provide for, either directly or through subcontracts, Medicare and Medicaid-covered servicesCovered Services, as well as additional items and services, under a capitated model of financing. CMS, the State, and the ICDS Plans FIDA-IDD Plan will ensure that beneficiaries Participants have access to an adequate network of medical and supportive services, including OPWDD services such as developmental disability, habilitation, prescription drugs and non-prescription drugs, behavioral health, and Community-based Long-Term Services and Supports (LTSS). CMS and the State shall have jointly select selected and will monitor the ICDS PlansFIDA-IDD Plan. As described in section III.A and detailed in Appendices 4 and 5 of this MOU, CMS will implement this initiative under Demonstration Medicare Parts C and D and demonstration authority for Medicare and Demonstration or State Plan Plan, demonstration, and waiver authority or waiver for Medicaid as described in section IIIA and detailed in Appendices 4 and 5Medicaid. Key objectives of the initiative are to improve the beneficiary Participant experience in accessing care, deliver person-centered care, promote independence in the community, improve quality, eliminate cost shifting between Medicare and Medicaid Medicaid, and achieve cost savings for the State and Federal government through improvements in care and coordination. CMS and the State expect this model of integrated care and financing to, among other things, improve quality of care and reduce health disparities, meet both health and functional needs, and improve transitions among care settings. Meeting beneficiary Other central goals of this initiative include: meeting Participant needs, including providing the ability opportunity to self-direct care, be involved increasing participant involvement in one’s her or his care, and providing the opportunity for Participants live as independently as possible in the community, are central goals of this initiative. CMS and the State expect ICDS Plans the FIDA-IDD Plan and provider implementation providers to focus on personal outcomes and consumer choice as well as follow the principles of the independent living and recovery philosophy, wellness principles, and cultural competence to contribute to achieving these goals. This philosophy is focused on helping adults with IDD to live the life they choose. The initiative will test the effect of an integrated care and payment model on serving both community and institutional populations. In order to accomplish these objectives, comprehensive Comprehensive contract requirements will specify access, quality, network, financial solvency, and oversight standards. Contract management will focus on performance measurement measurement, including the use of the Council on Quality and Leadership’s Personal Outcome Measures, and continuous quality improvement. Except as otherwise specified in this MOU, ICDS Plans the FIDA-IDD Plan will be required to comply with all applicable existing Medicare and Medicaid laws, rules, and regulations as well as Medicare and Medicaid program specific and evaluation requirements, as . Details will be further specified in a threeThree-way contract Contract to be executed among the ICDS PlansFIDA-IDD Plan, the State, and CMS. As part of this initiative, CMS and the State will test a new Medicare and Medicaid payment methodology designed to support ICDS Plans the FIDA-IDD Plan in serving Medicare-Medicaid Enrollees in the Demonstration. This financing approach will minimize cost-shifting, align incentives between Medicare and Medicaid, and support the best possible health and functional outcomes for EnrolleesParticipants. CMS and the State will allow for certain flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid Enrollees, utilizing a simplified and unified set of rules, as detailed in the sections below. Flexibilities will be coupled with specific beneficiary Participant safeguards and will be which are included in this MOU and will be provided in greater detail in the threeThree-way contractContract. ICDS Plans The FIDA-IDD Plan will have full accountability for managing the capitated payment to best meet the needs of Enrollees according to Participants. Person-Centered Individualized Care Plans Service Plans, also known as “Life Plans” (LP), will be developed by EnrolleesParticipants, their caregiverscircles of support, and Trans- disciplinary Care Management Teams the Interdisciplinary Team, using a person-centered planning process. CMS and the State expect ICDS Plans the FIDA-IDD Plan to achieve savings through better integrated and coordinated care. Subject to CMS and State oversightoversight and as authorized by law, ICDS Plans the FIDA-IDD Plan will have significant flexibility to innovate around care delivery and to provide a range of communityCommunity-based services as alternatives to or as means to avoid high-cost services if services, such as, but not limited to, Facility-based Long-Term Services and Supports, as indicated by the EnrolleesParticipants’ wishes, needs, and Individualized Care PlanLP. Preceding the signing of this MOU, the State has undergone necessary planning activities consistent with the CMS standards and conditions for participation, as detailed through supporting documentation provided in Appendix 2. This includes Stakeholder engagement specific to the FIDA-IDD Demonstration was limited while Federal-State discussions were pending. However, the stakeholder engagement did include a robust beneficiary- Participant- and stakeholder- engagement processprocess on the development of specialized managed care programs for individuals with IDD generally and the involvement of two OPWDD Commissioner-led advisory bodies, the Joint Advisory Council and the Transformation Panel. The Joint Advisory Council will focus on FIDA-IDD implementation and quality improvement during the Demonstration.

STATEMENT OF INITIATIVE. ‌ The Centers for Medicare & Medicaid Services (CMS) and the State Michigan Department of OhioCommunity Health (MDCH), Office of Medical Assistance (State/ Ohio Medicaid) Services Administration will establish a Federal-State partnership partner to implement the Demonstration to Develop an Integrated Integrate Care Delivery System for Persons Eligible for Medicare and Medicaid (Demonstration) to better serve individuals eligible for both Medicare and Medicaid (“Medicare-Medicare- Medicaid Enrolleesenrollees” or “dual eligibles”). The Federal-State partnership Demonstration will include a three-way contract with Integrated Care Delivery System Organizations (ICDSICOs) Plans that will provide integrated benefits to Medicare-Medicare- Medicaid Enrollees enrollees in the targeted geographic area(s). The Demonstration will begin on September no earlier than January 1, 2013 2015 and continue until through December 31, 20162017, unless terminated pursuant to section L III.L or continued pursuant to section K 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 Enrolleesenrollees, enhance quality of care and life, and reduce costs for both the State MDCH and the Federal 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 Demonstration is limited to "“Full Benefit" ” Medicare-Medicaid Enrollees enrollees who are age 18 21 or older. Section C.1 III.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 ICOs will be required to provide for, —either directly or or, through subcontracts, or through partnership with local Prepaid Inpatient Health Plans (PIHP)—all Medicare and Medicaid-covered services, as well as additional items and services, under a capitated model of financing. CMS, the StateMDCH, and the ICDS Plans ICOs will ensure that beneficiaries enrollees have access to an adequate network of medical and supportive services. CMS and the State MDCH shall jointly select and monitor the ICDS PlansICOs. CMS will implement this initiative under Demonstration demonstration authority for Medicare and Demonstration or demonstration, State Plan authority Plan, or waiver authority for Medicaid as described in section IIIA III.A and detailed in Appendices 4 and 5. Key objectives of the initiative are to:  Provide seamless access to improve the beneficiary experience in accessing care, deliver supports and services for Medicare-Medicaid enrollees  Create a person-centered care, promote independence in model to coordinate supports and services that communicates with and links back to all domains of the community, improve quality, eliminate delivery system  Streamline administrative processes for Medicare-Medicaid enrollees and providers  Eliminate barriers to and encourage the use of home and community based services  Provide quality services that also focus on enrollee satisfaction  Demonstrate cost shifting between Medicare and Medicaid and achieve cost savings effectiveness for the State state and Federal government federal governments through improvements improved supports and care coordination, financial realignment, promotion of best practices, and payment reforms. Team-based care is the provision of health and related support services to individuals, families, by at least two providers who work collaboratively with individuals and their caregivers to accomplish shared goals within and across settings to achieve coordinated, high-quality care. Recent collaborative efforts between MDCH’s Medicaid Health Plans PIHPs to improve physical health care outcomes for people served by these two entities have provided examples and lessons related to the importance of shared communication and coordination in care team-based care. From this experience, MDCH has gained insight into necessary quality strategies and coordinationmeasures that can be used to encourage coordination across team members. CMS and the State MDCH expect this model of integrated care and financing to, among other things, improve quality of care and care, reduce health disparities, meet both health and functional needs, and improve transitions among care settings. Meeting beneficiary enrollees’ needs, including the ability to self-self- direct care, be involved in one’s care, and live independently in the community, are central goals of this initiative. CMS and the State MDCH expect ICDS Plans to achieve these goals through ICO and provider implementation of the independent living and recovery philosophy, wellness principles, cultural competence, and cultural competence to contribute to achieving these goalspromotion of culture change. The initiative will test the effect of an integrated care and payment model on serving both community and institutional populations. In order to accomplish these objectives, comprehensive contract requirements will specify access, quality, network, financial solvency, and oversight standards. Contract management will focus on performance measurement and continuous quality improvement. Except as otherwise specified in this MOU, ICDS Plans ICOs will be required to comply with all applicable existing Medicare and Medicaid laws, rules, and regulations as well as program specific and evaluation requirements, as will be further specified in a three-way contract to be executed among the ICDS PlansICOs, the StateMDCH, and CMS. As part of this initiative, CMS and the State MDCH will test a new Medicare and Medicaid payment methodology designed to support ICDS Plans ICOs in serving Medicare-Medicaid Enrollees enrollees in the Demonstration. This financing approach will minimize cost-shifting, align incentives between Medicare and Medicaid, and support the best possible health and functional outcomes for Enrolleesenrollees. CMS and the State MDCH will allow for ICOs certain flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid Enrolleesenrollees, utilizing a simplified and unified set of rules, as detailed in the sections below. Flexibilities will be coupled with specific beneficiary enrollee safeguards and will be included in this MOU and the three-way contract. ICDS Plans ICOs will have full accountability for managing the capitated payment to best meet the needs of Enrollees enrollees according to Individualized Individual Integrated Care and Supports Plans developed by Enrolleesenrollees, their caregivers, and Trans- disciplinary Integrated Care Management Teams using a person-centered planning process. CMS and the State MDCH expect ICDS Plans ICOs to achieve savings through better integrated and coordinated care. Subject to CMS and State oversight, ICDS Plans ICOs will have significant flexibility to innovate around care delivery and to provide a range of community-based services as alternatives to or means to avoid high-cost services if indicated by the Enrolleesenrollees’ wishes, needs, and Individualized Individual Integrated Care and Supports Plan. Preceding the signing of this MOU, the State MDCH has undergone necessary planning activities consistent with the CMS standards and conditions for participation, as detailed through supporting documentation provided in Appendix 2. This includes a robust beneficiary- beneficiary and stakeholder- stakeholder engagement process.

STATEMENT OF INITIATIVE. ‌ The To establish a Federal-State partnership between the Centers for Medicare & Medicaid Services (CMS) and the State Commonwealth of Ohio, Office of Medical Assistance Massachusetts (State/ Ohio MedicaidCommonwealth/State/MassHealth) will establish a Federal-State partnership to implement the Demonstration to Develop an Integrated Integrate Care Delivery System 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 Integrated Care Delivery System Participating Plans and other qualified entities (ICDS“Participating Plans”) Plans that will provide integrated benefits to Medicare-Medicaid Enrollees in the targeted geographic area(s). The Demonstration will begin on September April 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 intended to alleviate the fragmentation and improve coordination of services for Medicare-Medicaid Enrollees, enhance quality of care and reduce costs for both the State Commonwealth and the Federal government. (See Appendix 1 for definitions of terms and acronyms used in this MOU.) The population that Individuals ages 21 through 64 at the time of enrollment who are enrolled in Medicare Parts A and B and eligible for Medicare Part D and MassHealth Standard or CommonHealth and who have no other comprehensive private or public health insurance will be eligible to participate for enrollment in the ICDS program is limited to "Full Benefit" Medicare-Medicaid Enrollees who are age 18 or older. Section this initiative, as discussed in more detail in 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 programbelow. Under this initiative, ICDS Participating Plans will be required to provide for, either directly or through subcontracts, Medicare and Medicaid-covered services, as well as additional supplemental items and services, under a capitated model of financing. CMS, the StateCommonwealth, and the ICDS Participating Plans will ensure that beneficiaries have access to an adequate network of medical and supportive services. CMS and the State Commonwealth shall jointly select and monitor the ICDS Participating 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 Commonwealth and Federal government through improvements in care and coordination. CMS and the State Commonwealth expect this model of integrated care and financing to, among other things, improve quality of care and reduce health disparities, meet both health and functional needs, and improve transitions among care settings. Meeting beneficiary needs, including the ability to self-direct care, be involved in one’s care, and live independently in the community, are central goals of this initiative. CMS and the State Commonwealth expect ICDS Plans Integrated Care Organization (ICO) and provider implementation of the independent living and recovery philosophy, wellness principles, and cultural competence to contribute to achieving these goals. The initiative will test the effect of an integrated care and payment model on serving both community and institutional populations. In order to accomplish these objectives, comprehensive contract requirements will specify access, quality, network, financial solvency, solvency and oversight standards. Contract management will focus on performance measurement and continuous quality improvement. Except as otherwise specified in this MOUMOU or the Massachusetts Section 1115 Demonstration, ICDS Participating Plans will be required to comply with all applicable existing Medicare and Medicaid laws, rules, and regulations as well as program specific and evaluation requirements, as will be further specified in a three-way contract to be executed among the ICDS Participating Plans, the StateCommonwealth, and CMS. As part of this initiative, CMS and the State Commonwealth will test a new Medicare and Medicaid payment methodology designed to support ICDS Participating Plans in serving Medicare-Medicaid Enrollees in the Demonstration. This financing approach will minimize cost-shifting, align incentives between Medicare and Medicaid, and support the best possible health and functional outcomes for Enrollees. CMS and the State Commonwealth will allow for certain flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid Enrollees, utilizing a simplified and unified set of rules, as detailed in the sections below. Flexibilities will be coupled with specific beneficiary safeguards and will be included in this MOU and the three-way contract. ICDS Participating Plans will have full accountability for managing the integrated blended capitated payment to best meet the needs of Enrollees according to Individualized Care Plans developed by Enrollees, their caregivers, and Trans- disciplinary Care Management Teams using a person-centered planning process. CMS and the State Commonwealth expect ICDS Participating Plans to achieve savings through better integrated and coordinated care. Subject to CMS and State Commonwealth oversight, ICDS Participating Plans will have significant flexibility to innovate around care delivery and to provide a range of community-based services as alternatives to or means to avoid high-cost traditional services if indicated by the Enrollees’ wishes, needs, needs and Individualized Care Plan. Preceding the signing of this MOU, the State Commonwealth has undergone necessary planning activities consistent with the CMS standards and conditions for participation, as detailed through supporting documentation provided in Appendix 2. This includes a robust beneficiary- and stakeholder- engagement process.