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Financial Alignment Initiative

Recent Posts: 

04/20/15 - The Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements for New York posted on the Information and Guidance for Plans page.

04/20/15 - The Medicare-Medicaid Plan (MMP) Submission of Plan Benefit Packages for Contract Year 2016 posted on the Information and Guidance for Plans page.

04/13/15 - The CY 2016 Medication Therapy Management (MTM) Program Guidance and Submission Instructions (4/7/15) posted on the Information and Guidance for Plans page.

04/10/15 - The updated Appendix 5: State-Specific Enrollment Guidance Requirements for Texas MMPs posted on the Information and Guidance for Plans page.

04/08/15 - The Outreach to Demonstration Eligible Individuals Memo (02/10/15) posted on the Information and Guidance for Plans page.

04/07/15 - The Applicability of the 2016 Final Call Letter for MMPs (04/07/15) posted on the Information and Guidance for Plans page.

03/27/15 - The updated Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements Memo (03/06/15) posted on the Information and Guidance for Plans page.

03/26/15 - The updated MMP Enrollment Technical Guidance (version 2.2) posted on the Information and Guidance for Plans page.

 

Overview

A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. To begin to address this issue, the Centers for Medicare & Medicaid Services (CMS) will test models with States to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports for their Medicare-Medicaid enrollees.

  • Capitated Model: A State, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care.
  • Managed Fee-for-Service (FFS) Model: A State and CMS enter into an agreement by which the state would be eligible to benefit from a portion of savings from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.

Qualifying states have an option to pursue one or both of the capitated or the FFS financial alignment models. In states with approved demonstrations, CMS will test these models over the next several years.

CMS is also working with some states to pursue demonstrations outside the capitated and FFS financial alignment models.

 

State Demonstrations

To participate in the Financial Alignment Initiative, each state had to submit a proposal outlining its proposed approach. All proposals were posted for public comments. 

When a State meets the standards and conditions for the Financial Alignment Demonstration, CMS and a State will develop a Memorandum of Understanding (MOU) to establish the parameters of the initiative.

 

Resources for Implementation

Implementation of each demonstration will be a collaborative effort between CMS and the state. CMS has made several resources available to assist states with implementation activities:

 

Additional Resources 

The Financial Alignment Initiative has two models, the capitated model and managed fee-for-service model. To learn more about enrollment, age, and health risk assessment (HRA) experiences to date for the capitated model visit the resource below: 

 

Information and Guidance for Plans