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Financial Alignment Initiative

Recent Posts: 

4/14/14 - Information about a new webinar series for providers working with individuals with developmental disabilities posted on the Medicare-Medicaid Coordination Office page. 

4/14/14 - The 2015 Plan Benefit Package (PBP) Training posted on the Information and Guidance for Plans page.

4/14/14 - The Ohio Spanish-language Medicare-Medicaid Plan (MMP) Member Handbook Chapters 1-3, 5-8, and 11 posted on the Information and Guidance for Plans page.

4/14/14 - A revised version of the California Integrated Denial Notice posted on the Information and Guidance for Plans page.

4/7/14 - The Ohio Spanish-language MMP templates for the Provider and Pharmacy Directory and List of Covered Drugs posted on the Information and Guidance for Plans page.

4/7/14 - The Ohio Ombudsman Technical Assistance Program award posted on the Funding to Support Ombudsman Programs page. 

4/3/14 - The Michigan memorandum of understanding (MOU) posted on the Michigan page.

3/28/14 - The Ohio MMP Member Handbook Chapters 4 and 10 posted on the Information and Guidance for Plans page.

3/27/14 - The MMP Monthly Enrollment Payment Data Guidance has been 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