Jan 26, 2011 - support the design of innovative service delivery and payment models for duals. Funds are for ... o Innov
Key CMMI Initiatives and Demonstrations In November, the Centers for Medicare and Medicaid Services (the entity within the Department of Health and Human Services responsible for administering Medicare and Medicaid) launched the new Center for Medicare and Medicaid Innovation. The Innovation Center is tasked with testing, evaluating, and rapidly expanding new ways to deliver and pay for health care services in Medicare and Medicaid that foster more patient-centered care and better care coordination, and reduce costs. At the launch, the CMMI announced four new initiatives:
Demonstration to Integrate Care for Dually Eligible Beneficiaries People eligible for both Medicare and Medicaid (known as dual eligibles) are some of the most vulnerable, high need, high cost beneficiaries – and the lack of coordination between Medicare and Medicaid further complicates their care. This demonstration project will examine programs that fully integrate care for dual eligibles. On December 13, the Innovation Center released an open solicitation for states to apply for funds to support the design of innovative service delivery and payment models for duals. Funds are for the development of demonstration proposals that describe how the state would structure, implement, and evaluate a model to improve the quality, coordination, and cost effectiveness of care for dual eligible individuals. CMS will evaluate those proposals, and select demonstration projects to implement beginning in 2012. Applications for design funding are due February 1, 2011. The Innovation Center will award up to 15 state program design contracts up to $1 million each. Additional Materials o Innovation Center website on duals demo: http://www.innovations.cms.gov/opportunities/opportunities.shtml
Medicaid State Option to Provide Health Homes for Enrollees with Chronic Conditions A new Medicaid state option will permit Medicaid enrollees with at least two chronic conditions to designate a provider as a health home. States that implement this option will receive enhanced financial resources (90% federal matching payments for two years for health home related services) to support “health homes” in their Medicaid programs.
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The Campaign for Better Care is led by the National Partnership for Women & Families, Community Catalyst, The Leadership Conference on Civil and Human Rights, and the National Health Law Program – and funded by The Atlantic Philanthropies.
Additional Materials o CMS Guidance on Electing State Option http://www.cms.gov/smdl/downloads/SMD10024.pdf
Expansion of the Multipayer Medical Home Demonstrations Under this demonstration, Medicare will participate in existing state multipayer health reform initiatives. These existing initiatives currently involve Medicaid and private health plans. The demonstration project will pay a monthly care management fee for beneficiaries receiving primary care from “advanced primary care” (aka medical home) practices. The care management fee will pay for care coordination, improved access, patient education and other services to support chronically ill patients. Additionally, each participating state will have mechanisms to offer medical home practices community support and linkages to state health promotion and disease prevention initiatives. Eight states have already been selected to participate: Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont. The demo will ultimately include more than 1,200 medical homes serving nearly one million Medicare beneficiaries. The demo will be fully operational by midyear 2011, and operate for 3 years. Additional Materials o Basic details on demo from CMS website: http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1230016 o CMS Q/A on demo: http://www.cms.gov/DemoProjectsEvalRpts/downloads/mapcpdemo_QA.pdf o CMS fact sheet on demo: http://www.cms.gov/DemoProjectsEvalRpts/downloads/mapcpdemo_Factsheet.pdf
Medicare Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration The FQHC medical home demonstration will test the effectiveness of doctors and other health professionals working in teams to treat low-income patients at community health centers. The demonstration will be conducted by the Innovation Center in up to 500 FQHCs, and aims to provide patient-centered, coordinated care to approximately 195,000 people with Medicare. The Innovation Center is expected to release additional details and a solicitation for applications soon.
Additional Materials o CMS website on FQHC Medical Home Demonstration: http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID =-99&sortByDID=3&sortOrder=descending&itemID=CMS1230557&intNumPerPage=10
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