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Financial Alignment Initiative

Recent Posts: 

8/29/14 - The Massachusetts Medicare-Medicaid Plan (MMP) Integrated Denial Notice posted on the Information and Guidance for Plans page.

8/29/14 - The Minnesota 2015 Summary of Benefits, Low Income Subsidy (LIS) Rider and Annual Notice of Change posted on the Information and Guidance for Plans page.

8/29/14 - The Illinois MMP Integrated and Drug-Only Explanation of Benefits (EOB) Models for CY 2015 posted on the Information and Guidance for Plans page.

8/29/14 - The New York MMP 2015 Member Handbook (Chapters 2 & 5) posted on the Information and Guidance for Plans page.

8/25/14 - The Spanish-language Massachusetts MMP 2015 Member Handbook, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, and Annual Notice of Change posted on the Information and Guidance for Plans page.

8/25/14 - The Spanish-language Ohio MMP 2015 Member Handbook, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, and Annual Notice of Change posted on the Information and Guidance for Plans page.

8/25/14 - The New York MMP 2015 Member Handbook (Chapters 10 & 12), Part D Model Excluded Provider Letter and Part D Model Prescription Transfer Letter posted on the Information and Guidance for Plans page.

8/21/14 - The Ohio MMP 2015 Final EOB and Delegated Notice (5a) posted on the Information and Guidance for Plans page.

8/21/14 - The Virginia MMP 2015 Delegated Notices (5a, 29) posted on the Information and Guidance for Plans page.

8/15/14 - The Reporting Requirement Templates have been posted on the Information and Guidance for Plans page. 

8/12/14 - The Virginia MMP Reporting Requirement Templates (ongoing data collection tool) 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.

The 15 States that received design contracts under the State Demonstrations to Integrate Care for Dual Eligible Individuals may choose to pursue these models and use their planning contract and stakeholder processes to support the development of the demonstration proposal.

 

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