1. Update on CMS Financial Alignment Initiative and State Integration Efforts Inside and Outside Demonstration Authority
Lindsay Barnette
Medicare-Medicaid Coordination Office
Centers for Medicare & Medicaid Services
March 30, 2015

2. Overview Medicare-Medicaid Coordination Office Overview
CMS Financial Alignment Initiative Update
Efforts to support integration of Medicare and Medicaid outside of the demonstration context

3. Medicare-Medicaid Coordination Office
Section 2602 of the Affordable Care Act
Purpose: Improve quality, reduce costs and improve the beneficiary experience.
Ensure Medicare-Medicaid enrollees have full access to the services to which they are entitled.
Improve the coordination between the federal government and states.
Identify and test innovative care coordination and integration models.
Eliminate financial misalignments that lead to poor quality and cost shifting.

4. Medicare-Medicaid Enrollee Delivery System Transformation
CURRENT STATE
Provider and Payor-Centered
Fragmented Care
Volume-Driven
Complicated Benefit Overlap
FUTURE STATE
Person-Centered
Coordinated Care
Outcomes-Driven
Simplified Processes 4

5. Financial Alignment Initiative
In 2011, CMS announced new models to integrate the service delivery and financing of both Medicare and Medicaid through Federal-State demonstrations to better serve the population.
Goal: Increase access to quality, seamlessly integrated programs for Medicare-Medicaid enrollees.
Demonstration Models:
Capitated Model: Three-way contracts among States, CMS and health plans to provide comprehensive, coordinated care in a more cost- effective way.
Managed FFS Model: Agreements between States and CMS under which states would be eligible to benefit from savings resulting from initiatives to reduce costs in both Medicaid and Medicare.

6. The Vision
The Financial Alignment Initiative will promote an improved experience for beneficiaries by:
Focusing on person-centered models that promote coordination missing from today’s fragmented system
Developing a more easily navigable and simplified system of services for beneficiaries
Ensuring beneficiary access to needed services and incorporating beneficiary protections into each aspect of the new demonstrations
Establishing accountability for outcomes across Medicaid and Medicare
Requiring robust network adequacy standards for both Medicaid and Medicare
Evaluating data on access, outcomes and beneficiary experience to ensure beneficiaries receive higher quality, more cost-effective care

7. Examples of Beneficiary Enhancements
Person-centered care planning
Choice of plans and providers
Continuity of care provisions
Care coordination and assistance with care transitions
Enrollment assistance and options counseling
One identification card for all benefits and services
Single statement of all rights and responsibilities
Integrated grievances and appeals process
Maximum travel and distance times
Limitations on wait and appointment times

8. Financial Alignment Initiative: Where We AreDC
KEY:
Capitated Model
Fee-For-Service Model
Alternative Model
Live States 8

9. Financial Alignment Initiative Update
Nine states have approved capitated financial alignment models: California, Illinois, Massachusetts, Michigan, New York, Ohio, South Carolina, Texas, and Virginia.
Two states have approved managed fee-for-service financial alignment models: Colorado and Washington State.
Minnesota has an alternative model to integrate care for Medicare-Medicaid enrollees building on the state’s current infrastructure.
We are working with additional states to participate in the initiative.

10. The Alignment Initiative
Background: In 2011, the Medicare-Medicaid Coordination Office compiled the Opportunities for Alignment List, which included a broad range of content areas in which the Medicare and Medicaid programs have conflicting requirements or create incentives that prevent Medicare-Medicaid enrollees from receiving seamless, high quality care.
Goal: Identify and implement solutions that advance better care, improve health, and lower costs through improvements.
Examples:
Cost-sharing: Raise Awareness of Prohibition Against Balance Billing 
Appeals: Integrated Denial Notice For Medicare/Medicaid and Medicare Advantage plans 
Durable Medical Equipment: Access to effective repairs, especially for new Medicare-Medicaid enrollees.  

11. Legislative Recommendations in the FY 2014 Report to Congress
Create pilot to expand PACE eligibility to ages 21-55;
Ensure retroactive Part D coverage of newly-eligible low income beneficiaries;
Establish integrated appeals process for Medicare-Medicaid enrollees; and
Allow for Federal/state coordinated review of Duals Special Needs Plan marketing materials.

12. Supporting Integration via D-SNPs
Minnesota Alternative Model Demonstration
Integrated Care Resource Center (ICRC) Technical Assistance to States
Example: D-SNP Contracting TA Tool
Administrative flexibilities for integrated D-SNPs
Existing options
New areas for exploration

13. Medicare-Medicaid Coordination Office
More Information
Medicare-Medicaid Coordination Office
Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/