Financial Alignment Initiative (FAI)
|03/28/2018 - The newly-executed Rhode Island (RI) three-way contract, and summary of contract changes, posted on the Rhode Island page.|
|02/05/2018 - The newly-executed California (CA) three-way contract, and summary of contract changes, posted on the California page.|
OverviewA 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.
- Learn more about the Capitated Model.
- 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.
- Learn more about the FFS Model.
DemonstrationsCMS is providing an opportunity for three demonstration states with current end dates of December 31, 2018 -- Massachusetts, Minnesota, and Washington -- to extend the scheduled end dates for the demonstrations until December 31, 2020. CMS has asked that each interested state submit a non-binding letter of intent by March 1, 2017.
Resources for ImplementationImplementation 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:
- Funding to Support Options Counseling for Medicare-Medicaid Enrollees
- Funding to Support Ombudsman Programs
- Implementation Support for State Demonstrations (application period has closed)
- Integrated Care Resource Center
Additional ResourcesThe Financial Alignment Initiative has two models, the capitated model and managed fee-for-service model. To learn more about enrollee experiences with the capitated and managed fee-for-service model demonstrations to date visit the resource below:
Please visit Information and Guidance for Plans to learn more about information and guidance for Medicare-Medicaid Plans (MMPs) participating in the capitated model demonstrations and the Minnesota Demonstration to Integrate Care for Dual Eligibles in the areas of:
- Application & Annual Requirements
- Reporting Requirements
- Audit Programs
- Encounter Data Reporting
- Marketing Information & Resources
- Quality Withhold Methodology & Technical Notes
- Chronic Care Improvement Programs & Quality Improvement Projects
- Page last Modified: 04/03/2018 6:26 AM
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