Capitated Model

SPOTLIGHT & RELEASES

04/01/2020: CMS released 2020 Medicare-Medicaid Plan Performance Data including:

2020 MMP Performance Data Technical Notes (PDF)

2020 MMP Performance Data File (XLSX)

03/13/2020: CMS released revised information on the NY FIDA, NY FIDA-IDD, & NY Integrated Appeals and Grievances, Demonstrations including the MOU, Evidence of Coverage, MAP Handbook, CY 2020 ANOC, and Integrated Beneficiary Notices for the NY Integrated Appeals and Grievances Demonstration

 

Under the capitated model, the Centers for Medicare & Medicaid Services (CMS), a state, and a health plan enter into a three-way contract to provide comprehensive, coordinated care.

In the capitated model, CMS and the state will pay each health plan a prospective capitation payment. More information on rate setting:

Medicare-Medicaid Plan Performance Data

Under the capitated model, CMS is collecting a variety of measures that examine plan performance and the quality of care provided to enrollees. The Medicare-Medicaid Plan (MMP) performance data published here represent currently available data on MMP performance on certain Medicare Parts C and D quality measures as well as select CMS core and state-specific measures that MMPs are required to report.

For additional information on the longer term vision for a quality ratings strategy and the way that information on MMP performance will be publicly reported during the interim period see:  

State Demonstrations

To participate in the Financial Alignment Initiative, each state had to submit a proposal outlining its proposed approach. States interested in the new financial alignment opportunities were required to submit a letter of intent by October 1, 2011. When a proposal meets the standards and conditions for the Financial Alignment Initiative, CMS and a state will develop a memorandum of understanding (MOU) to establish the parameters of the demonstration. 

Prior to enrolling or marketing under the capitated model, each health plan must pass a readiness review.

Visit these pages for more information about CMS approved demonstrations in specific states:

For more information, please email MMCOcapsmodel@cms.hhs.gov

Page Last Modified:
04/02/2020 01:59 PM