FOR IMMEDIATE RELEASE
July 30,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS
and Rhode Island Partner to Coordinate Care for Medicare-Medicaid Enrollees
On July 30, 2015, the Centers for Medicare &
Medicaid Services (CMS) announced that CMS is partnering with the State of
Rhode Island to test a new model for providing Medicare-Medicaid enrollees with
a more coordinated, person-centered care experience.
Background
The demonstration builds upon Rhode Island’s
existing Integrated Care Initiative. Under Phase I of the Integrated Care
Initiative, Rhode Island established the Rhody Health Options (RHO) Medicaid
managed care program. In RHO, Medicaid members – including Medicare-Medicaid
enrollees – enroll in a health plan that coordinates their Medicaid services,
including long-term services and supports. The new demonstration will allow a
contracted, qualifying RHO plan to also serve as a Medicare-Medicaid Plan (MMP)
that will newly cover Medicare benefits in addition to the existing set of
Medicaid benefits it currently offers, allowing for an integrated set of
benefits for enrollees.
Medicare-Medicaid Enrollees
Improving the care experience for low-income
seniors and people with disabilities who are Medicare-Medicaid enrollees –
sometimes referred to as “dual eligibles” – is a priority for CMS.
Currently, Medicare-Medicaid enrollees navigate
multiple sets of rules, benefits, insurance cards, and providers (e.g. Medicare
Parts A and B, Part D, and Medicaid). Many Medicare-Medicaid enrollees suffer
from multiple or severe chronic conditions and could benefit from better care
coordination and management of health care and long-term services and supports.
The Financial Alignment Initiative – Partnerships to
Provide Better Care
Through the demonstrations approved under the
Financial Alignment Initiative, CMS seeks to provide Medicare-Medicaid
enrollees with a better care experience by offering a person-centered,
integrated care initiative that provides a more easily navigable and seamless
path to all covered Medicare and Medicaid services.
In July 2011, CMS announced the opportunity for
states to partner with CMS through one of two models:
·
Managed
Fee-for-Service Model
in which a state and CMS enter into an agreement through which the state is
eligible to benefit from savings resulting from initiatives designed to improve
quality and reduce costs for both Medicare and Medicaid;
·
Capitated
Model in
which a state and CMS contract with health plans or other qualified entities
that receive a prospective, blended payment to provide enrolled
Medicare-Medicaid enrollees with coordinated care.
The Rhode Island demonstration uses the Capitated
Model.
The Integrated Care Initiative
Rhode Island currently operates Phase I of the
Integrated Care Initiative, which is designed to provide enhanced care
coordination services to Medicaid members, including those dually eligible for
Medicaid and Medicare. Under Phase I of the Initiative, eligible Medicaid
members may enroll in either an enhanced Primary Care Case Management model
called Connect Care Choice Community Partners (CCCCP) or the Rhody Health
Options Medicaid managed care program for their Medicaid benefits.
The Rhode Island Demonstration
Under the new Rhode Island demonstration, which is part
of Phase II of the Integrated Care Initiative, the participating MMP will cover
Medicare benefits in addition to the Medicaid benefits currently covered
through RHO. This change will allow the MMP to offer Medicare-Medicaid
enrollees an integrated set of benefits to more comprehensively address their
individual service needs. Approximately 30,000
individuals will be eligible to enroll in the demonstration.
To ensure the MMP is prepared
to serve Medicare-Medicaid enrollees, any participating plan must first meet
core Medicare and Medicaid requirements, state procurement standards, and state
insurance rules (as applicable). The plan must also pass a comprehensive
readiness review operated by both CMS and the state.
Enrollment is scheduled to begin no sooner than
December 1, 2015 with at least two months of opt-in only enrollment, followed
by at least three waves of phased passive enrollment.
Putting the Beneficiary First
Care Coordination
Under the demonstration, care
coordination services will be available to all enrollees. The
participating MMP will offer a service coordination
team to ensure the integration of the enrollee’s medical, behavioral health,
long-term services and supports, and social needs. The team will be built on
the enrollee’s specific preferences and goals.
Quality Measures
The new demonstration includes beneficiary protections
to ensure that enrollees receive high-quality care. CMS and Rhode Island have
established quality measures relating to the beneficiary’s overall experience,
care coordination, and fostering and supporting community living, among many
others.
Other
Protections
The
demonstration also includes continuity of care requirements to ensure that
enrollees can continue to see their current providers during their transitions
into the MMP. The Rhode Island Ombudsman program will
support individual advocacy and provide Rhode Island and CMS with feedback on
plan performance for the demonstration, with a focus on compliance with
principles of community integration, independent living, and person-centered
care.
Comprehensive
Evaluation
CMS is funding and managing
an external evaluation of each demonstration under the Financial Alignment
Initiative. The evaluation for the Rhode Island demonstration will measure
quality, including overall beneficiary experience of care, care coordination,
and support of community living, as well as changes in Medicare and Medicaid
costs. CMS will develop a unique, Rhode Island-specific evaluation using a
comparison group to analyze the impact of the demonstration.
A Transparent Process Supporting Public Input
The Rhode Island demonstration is the product of an ongoing
planning and development process through which the public helped shape the
demonstration’s design. To develop this demonstration, Rhode Island:
·
Worked with a diverse group of
stakeholders, including beneficiaries, providers, health plans, advocacy
groups, associations, and state agencies;
·
Held public information sessions
with external stakeholders to inform demonstration development and policy; and
o
Posted its draft proposal for public
comment and incorporated the feedback into its demonstration proposal before
officially submitting it to CMS. The proposal was then posted by CMS for public
comment.
Additional Information
Additional
information about the Rhode Island demonstration, including the Memorandum of
Understanding (MOU) between CMS and the state that establishes the
demonstration parameters, is available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/RhodeIsland.html.
For more
information about the Financial Alignment Initiative, please visit:
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