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SCDuE Weekly Update | March 8, 2013

 

SCDuE Demonstration Update #9

As of Friday, March 8, 2013, the proposed model of the South Carolina Dual Eligible (SCDuE) Demonstration continues to be reviewed by the Centers for Medicare and Medicaid Services (CMS). We will continue to move forward with planning activities for a 2014 implementation of the SCDuE Demonstration.

INTEGRATED CARE WORKGROUP MEETING

March 27, 2013, 10:00am – 12:30pm

Phillips Market Center at the South Carolina State Farmers Market

3501 Charleston Highway

West Columbia, South Carolina

Directions

The next Integrated Care Workgroup will be Wednesday, March 27th, 10am – 12:30pm, at the Phillips Market Center.  Members of the Integrated Care Workgroup (ICW), as well as other stakeholders will receive a formal invitation via email.
 
Our guest speaker is Lynda Flowers, a Strategic Policy Advisor in the Public Policy Institute at AARP.  Ms. Flowers will present information on consumer protection and its impact on the Demonstration.  She will also share examples of how other states have integrated such protections in their program design.  Ms. Flowers’ presentation will be followed by a discussion of this topic and its application in South Carolina’s Demonstration.  If you interested in attending this event, please RSVP at scdue@scdhhs.gov by Friday, March 22, 2013.
 
Lynda Flowers is a Strategic Policy Advisor in the Public Policy Institute at AARP.  In this senior-level position, Lynda conducts health policy research and provides strategic policy analysis on a number of health-related issues of importance to AARP’s Social Impact Agenda, Member Value Strategy, and the Association’s Divided We Fail initiative.  Lynda covers the following issues for AARP:  Medicaid and other Low-Income Health Issues, Racial and Ethnic Disparities, Public Health, and Women’s Health.
 
Before joining AARP, Lynda held senior-level health policy positions at the National Academy for State Health Policy (NASHP) and the District of Columbia’s Medical Assistance Administration (MAA).  While at MAA, Lynda was instrumental in developing the District’s first Home and Community-based Waiver for the Elderly and the State Children’s Health Insurance Program.  Lynda has also held health policy positions with the National Conference of State Legislatures and the League of Women Voters.
 
Lynda received her JD from Golden Gate University Law School, where she also served on Law Review; her MSN from Georgetown University; a BS in Nursing from the University of Wisconsin; and a Certificate in Public Health Leadership from the University of North Carolina at Chapel Hill.

 

PLAN SELECTION PROCESS

The MMP application process and South Carolina’s procurement process are both confidential.  Neither CMS nor the State will release the names of organizations that are pursuing these contracts.  Once contracts have been formalized and signed, both CMS and the State will release the names of those entities.

 

JOINT RATE-SETTING PROCESS UNDER THE CAPITATED FINANCIAL ALIGNMENT DEMONSTRATION

The purpose of this updated document is to provide states and other interested parties with additional information on the mechanism for developing payment rates for plans responsible for coordinating the full array of primary, acute, behavioral health and long-term supports and services for Medicare-Medicaid enrollees under the Demonstration.

Through this joint rate-setting process, Medicare and Medicaid will coordinate in setting payment levels and both payers will prospectively share in the savings achievable through the Demonstrations.

  • Available on the CMS-MMCO Website: The Joint Rate-Setting Process for the Capitated Financial Alignment Model | PDF

 

OTHER DEMONSTRATION STATE ACTIVITIES AND CMS UPDATES

  1. On February 22, 2013, HHS announced that Illinois is the 4th Financial Alignment Demonstration (FAD) state to receive approval for its MOU.  This is the 3rd demonstration state to receive CMS approval for a capitated demonstration.  Illinois’ Demonstration will begin October 1, 2013, subject to the conditions described in the Memorandum of Understanding (MOU).
  2. Michigan issued a notice to potential bidders regarding participation in the Demonstration as an Integrated Care Organization (ICO) on February 13, 2013.  This notice included details on the MMP selection process, contract structure, and Request For Proposals.
  3. The Department of Health Care Services in California received a letter from CMS-MMCO Director Melanie Bella on February 1, 2013 describing the ongoing work to develop the Demonstration to Integrate Care for Dual Eligible Beneficiaries.
  4. In February 2013, CMS-MMCO released a Report on Trends in Enrollment and Eligibility (2006 through 2011).  This report is the result of a CMS-MMCO analytic project.

 
 
DEMONSTRATION STATES WITH MEMORANDUMS OF UNDERSTANDING (MOUs)

  1. Massachusetts (capitated) | MOU
  2. Ohio (capitated) | MOU
  3. Washington (Managed Fee-For-Service (M-FFS)) | MOU
  4. Illinois (Capitated) | MOU

 

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Medicare-Medicaid FAQs (Frequently Asked Questions) | PDF
 
Contact CMS for any questions or concerns regarding the meetings, guidance, or the MMP application. Emails can be directed to MMCOcapsmodel@cms.hhs.gov
 
Contact the SCDuE Team for more information, questions, and/or comments related to the SCDuE Demonstration by email at scdue@scdhhs.gov.
 
For additional assistance, please contact the SCDuE Program Coordinator, Teeshla Curtis by email at curtist@scdhhs.gov or by telephone at (803) 898-0070.
 
Visit the SCDuE Website at https://msp.scdhhs.gov/scdue/
 
Visit the CMS-MMCO Website at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html

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