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Financial Alignment Initiative

Recent Posts: 

01/29/15 - The South Carolina Medicare-Medicaid Plan (MMP) CY 2015 Integrated Denial Notice (IDN) posted on the Information and Guidance for Plans page.

01/28/15 - The New York Fully Integrated Duals Advantage (FIDA) Evaluation Design Plan posted on the Evaluation page.

01/27/15 - The Washington MMP CY 2015 Marketing Guidance posted on the Information and Guidance for Plans page.

01/26/15 - The Michigan MMP State-Specific Enrollment Guidance and updated Delegated Notices (5a & 5b) posted on the Information and Guidance for Plans page.

01/23/15 - The updated Core Reporting Requirements (Pharmacy Rejected Claims Template) posted on the Information and Guidance for Plans page.

01/23/15 - The Spanish-language South Carolina MMP CY 2015 Member Handbook (Chapters 4, 5, 9 & 12), List of Covered Drugs, Summary of Benefits and Provider Pharmacy Directory posted on the Information and Guidance for Plans page.

01/22/15 - The Texas MMP CY 2015 Marketing Guidance, Member Handbook (Chapters 1 & 4), Delegated Notices (5a, 5b, 21, 27 & 29) and updated Member ID Card posted on the Information and Guidance for Plans page.

01/22/15 - The updated New York FIDA Plan State-Specific Enrollment Guidance posted on the Information and Guidance for Plans page.

01/16/15 - The Texas Dual Eligible Integrated Care Project State-Specific Enrollment Guidance 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:

 

Information and Guidance for Plans