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Financial Alignment Initiative

Recent Posts: 

02/24/16 - The Capitated Financial Alignment Demonstration Medicare-Medicaid Plan (MMP) Annual Requirements for CY 2016 posted on the Information and Guidance for Plans page.

02/19/15 - Request for input related to the Provider and Pharmacy Directory model template posted on the Information and Guidance for Plans page.

02/19/15 - The New York Fully Integrated Duals Advantage (FIDA) Plan Pharmacy Provider Frequently Asked Questions (FAQs) posted on the New York page.

02/19/15 - The New York FIDA Plan Appeal and Grievance Notices and the attachment to forward an appeal to the IAHO posted on the Information and Guidance for Plans page.

02/18/15 - The Financial Alignment Initiative Enrollment, Age and Health Risk Assessment as of January 2015 posted on this page. 

02/18/15 - The Texas Dual Eligible Integrated Care Project Home Health Provider FAQs posted on the Texas page.

02/12/15 - The MyCare Ohio Provider Outreach Letter posted on the Ohio page. 

02/11/15 - The South Carolina Healthy Connections Prime Provider FAQs posted on the South Carolina page.

02/10/15 - The updated New York FIDA Plan Delegated Notice (Exhibit 30) 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