State Demonstrations to Integrate Care for Dual Eligible Individuals

Added: Nov 16, 2010 5:04 pm Modified: Nov 18, 2010 3:53 pmTrack Changes The Center for Medicare and Medicaid Innovation (CMMI) is partnering with the Federal Coordinated Health Care Office (FCHCO), established by section 2602 of the Affordable Care Act, to evaluate models (as described in Section 3021(b)(2)(B)(x) & (xi)) that: 1) fully integrate care for dual eligible individuals, 2) provide the management of all funds with respect to such individuals, and 3) develop models that allow states to test and evaluate systems of all-payer payment reform for the medical care of residents of the state. Section 3021 of the Affordable Care Act provides a framework that allows CMMI to design and evaluate such models pertaining to dual eligible individuals.

Under the above ACA sections, CMS, through CMMI in concert with the FCHCO, will develop effective partnerships with states by providing them with the opportunity to enter into innovation contracts with CMS that shall result in integrated care models for dually eligible individuals.

The state innovation contracts for integrated care will be structured into two phases: (1) program/model design and (2) state implementation. The primary outcome of the program design contract will be a proposed state innovation demonstration model that describes how the state would structure, implement, and evaluate an intervention aimed at improving the quality, coordination, and cost-effectiveness of care received by individuals dually eligible for Medicare and Medicaid.

In the initial phase, CMS may award up to 15 state program design contracts up to $1 million each. States that successfully complete the program design contract will be eligible to proceed to the implementation phase. The receipt of a program design contract does not guarantee support for the implementation phase, and; states will have to satisfy program design contract deliverables and meet all applicable conditions for CMS to exercise that option. The state implementation phase would include costs to prepare state infrastructure for conducting the model demonstration. These development and infrastructure costs may include systems change costs at the state-level for testing a new payment approach, development of a more efficient data exchange feed for near real-time tracking of claims, and additional resources necessary to ensure successful implementation of the model demonstration.

THIS SOLICITATION IS RESTRICTED TO THE STATES MEDICARE AND MEDICAID PROGRAMS ONLY.

Added: Nov 16, 2010 5:04 pm The Center for Medicare and Medicaid Innovation (CMMI) is partnering with the Federal Coordinated Health Care Office (FCHCO), established by section 2602 of the Affordable Care Act, to evaluate models (as described in Section 3021(b)(2)(B)(x) & (xi)) that: 1) fully integrate care for dual eligible individuals, 2) provide the management of all funds with respect to such individuals, and 3) develop models that allow states to test and evaluate systems of all-payer payment reform for the medical care of residents of the state. Section 3021 of the Affordable Care Act provides a framework that allows CMMI to design and evaluate such models pertaining to dual eligible individuals.

Under the above ACA sections, CMS, through CMMI in concert with the FCHCO, will develop effective partnerships with states by providing them with the opportunity to enter into innovation contracts with CMS that shall result in integrated care models for dually eligible individuals.

The state innovation contracts for integrated care will be structured into two phases: (1) program/model design and (2) state implementation. The primary outcome of the program design contract will be a proposed state innovation demonstration model that describes how the state would structure, implement, and evaluate an intervention aimed at improving the quality, coordination, and cost-effectiveness of care received by individuals dually eligible for Medicare and Medicaid.

In the initial phase, CMS may award up to 15 state program design contracts at $1 million each. States that successfully complete the program design contract will be eligible to proceed to the implementation phase. The receipt of a program design contract does not guarantee support for the implementation phase, and; states will have to satisfy program design contract deliverables and meet all applicable conditions for CMS to exercise that option. The state implementation phase would include costs to prepare state infrastructure for conducting the model demonstration. These development and infrastructure costs may include systems change costs at the state-level for testing a new payment approach, development of a more efficient data exchange feed for near real-time tracking of claims, and additional resources necessary to ensure successful implementation of the model demonstration.

THIS SOLICITATION IS RESTRICTED TO THE STATES MEDICARE AND MEDICAID PROGRAMS ONLY.