Report Fraud

CMS Demonstration Resources

CMS Demonstration Resources


Financial Alignment Materials

The CMS documents and materials listed below are intended for interested Health Plans and can be found on the CMS-MMCO website.

 

February 2013

Joint Rate-Setting Process Under the Capitated Financial Alignment Demonstration

Posted on the CMS-MMCO website February 2013

This document describes a joint rate-setting process for Medicare-Medicaid capitated financial alignment model. Through this model, participating health plans are responsible for delivering an integrated set of services for Medicare-Medicaid enrollees. This initiative will test whether aligning Medicare and Medicaid financing can foster more person-centered care models of care, achieve better outcomes, and lower costs through improvement.

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

 

January 2013

2014 Application Information for Medicare-Medicaid Plans

Posted on the CMS-MMCO website January 2013

For interested organizations seeking to participate in the capitated Financial Alignment demonstration beginning in 2014, the application deadline is 8:00 p.m. Eastern Time (Baltimore, MD) on February 21, 2013.

  • Please click here for the 2014 Medicare Medicaid Application. The application is also available to download below. Additional information and guidance on the 2014 MMP application is also available here.
  • Please click here to access the slides for the 2014 MMP Application Training Webinar held on Thursday, January 17, 2013.

 

 

December 17, 2012

Medicare-Medicaid Capitated Financial Alignment Demonstration MMP Readiness Review Presentation

Posted on the CMS-MMCO website Monday, December 17, 2012

The readiness review is one aspect of the multi-pronged oversight strategy for preserving and strengthening Medicare-Medicaid enrollees’ access to and quality of care under the Financial Alignment Demonstration.

The Presentation is available for download from this link.

 

November 28, 2012

Readiness Reviews

Posted on the CMS-MMCO website Thursday, November 28, 2012

As part of the Medicare-Medicaid Capitated Financial Alignment Demonstration, the Centers for Medicare & Medicaid Services (CMS) and participating States want to ensure that every selected Medicare-Medicaid plan (MMP) is ready to accept enrollment, protect and provide the necessary continuity of care, ensure access to the spectrum of Medicare, Medicaid, and pharmacy providers most frequently utilized by the Medicare-Medicaid population, and fully meet the diverse needs of the Medicare-Medicaid population. In order to ensure the demonstrations will preserve and strengthen Medicare-Medicaid enrollees’ access to care, quality of care, and benefits, CMS and the States will assess MMPs’ ability to implement and continue operations under the demonstration.

This CMS Memo is addressed to Medicare-Medicaid Plans and includes additional details and attachments explaining the Massachusetts readiness review plan.

 

October 22, 2012

2014 Notice of Intent to Apply (NOIA) and Applicaiton Informatin for Medicare-Medicaid Plans

Posted on the CMS-MMCO website Monday, October 22, 2012

For interested organizations seeking to participate in the capitated Financial Alignment Demonstration beginning in 2014, the NOIA deadline to ensure access to the CMS Health Plan Management System is November 14, 2012.  Please use the NOIA Web Tool, accessible from this link:  https://vovici.com/wsb.dll/s/11dc4g51421

The NOIA memo includes 2014 Contract Year deadlines and is available for download from this link.

 

September 20, 2012

Waiver of Part D Low-Income Subsidy Cost-Sharing Amounts by Medicare-Medicaid Plans and Operational Implications for Prescription Drug Event Data and Plan Benefit Package Submissions

As specified in previous guidance, including our January 25, 2012 HPMS memorandum, entitled, “Guidance for Organizations Interested in Offering Capitated Financial Alignment Demonstration Plans,” Medicare-Medicaid Plans will be paid for Part D-covered drugs according to the standard Part D payment rules, with the exception that the direct subsidy will be based not on a bid submitted by each plan, but on the standardized national average bid monthly amount (NAMBA). The NAMBA will be risk adjusted according to the same rules that apply to all other Part D plans. Medicare-Medicaid Plan enrollees will be subject to standard low-income subsidy (LIS) copayment levels, absent any further reduction in cost sharing at plans’ election.

Any questions on the contents of this memorandum should be directed to mmcocapsmodel@cms.hhs.gov.

  • Link to document | PDF

 

 

May 31, 2012

Follow up on CY 2013 Part D Supplemental Formulary File and Additional Demonstration Drug File Submission Requirements for Financial Alignment Demonstration Plan Applicants

The purpose of this memorandum is to clarify issues and questions that Financial Alignment Demonstration Plan (FAD) applicants have raised following the release of our May 3, 2012 HPMS guidance memorandum entitled, “CY 2013 Part D Supplemental Formulary File and Additional Demonstration Drug File Submission Requirements for Financial Alignment Demonstration Plan Applicants.” These instructions apply only to FAD applicants.

  • Link to document | PDF

 

May 25, 2012

Additional Guidance on the Model of Care Submission Requirements for CY 2013 Financial Alignment Demonstration Applicants

On May 8, 2012, CMS announced that there would be a delay in the deadline for submission of Financial Alignment Demonstration (FAD) contracts’ model of care (MOC). This memorandum provides guidance on the revised submission process and timelines.

  • Link to document | PDF

 

May 3, 2012

CY2013 Part D Supplemental Formulary File and Additional Demonstration Drug File Submission Requirements for Financial Alignment Demonstration Plan Applicants

The purpose of this memorandum is to: (1) clarify the supplemental formulary submission requirements for Financial Alignment Demonstration plan applicants; (2) provide more information about the Additional Demonstration Drug (ADD) File referenced in our March 29, 2012 guidance memorandum for organizations interested in offering Financial Alignment Demonstration plans in 2013; and (3) announce a teleconference that will be conducted on this guidance for demonstration plan applicants on May 9, 2012.

  • Link to document | PDF

 

April 17, 2012

HPMS CY2013 Financial Alignment Demo Application Training (Presentation)

CMS's Greg Buglio of the Division of Plan Data & the Medicare Drug Benefit and C & D Data Group presents instructions for accessing and using the Health Plan Management System (HPMS) for online applications.  Contact information for general assistance, technical assistance and other HPMS questions is provided on slide #60 of this presentation.

  • Link to document | PDF

 

March 29, 2012

Additional Guidance on the Medicare Plan Selection Process for Organizations Interested in Offering Capitated Financial Alignment Demonstration Plans in 2013

On January 25, 2012, the Centers for Medicare and Medicaid Services (CMS) issued an initial guidance memorandum for organizations interested in offering capitated financial alignment demonstration plans in interested States in contract year (CY) 2013. In that memorandum, CMS provided information about: (1) the payment principles underlying the demonstration; (2) standards in key programmatic areas; (3) State demonstration approval process key dates; (4) a number of Medicare plan selection process key dates; (5) submission of a notice of intent to apply as a demonstration plan; and (6) network adequacy determinations for Medicare-covered services. This guidance document offers additional information for interested organizations

  • Link to document | PDF

 

March 23, 2012

2013 Capitated Financial Alignment Demonstration Application

The Centers for Medicare & Medicaid Services (CMS) is seeking applications from qualified entities to enter into contracts with the CMS and applicable States to offer integrated Medicare and Medicaid services to dual eligible individuals.

  • Link to document | PDF

 

February 16, 2012
States that submitted non-binding Letters of Intent

This document lists the States that have submitted letters of intent to CMS and are continuing to explore pursuing one or both of the Medicare-Medicaid financial alignment models described in the July 8, 2011, State Medicaid Directors’ letter. These models are intended to improve beneficiary experiences and quality outcomes, while also reducing costs for individuals eligible for both Medicaid and Medicare.

  • Link to document | PDF

 

January 2012

Medicare-Medicaid Financial Alignment Demonstrations - Standards and Conditions

This document provides a list that highlights the essential elements that CMS will look for in any State’s demonstration proposal.

  • Link to document | PDF

 

January 25, 2012

Guidance for Organizations Interested in Offering Capitated Financial Alignment Demonstration Plans

  • Link to document | PDF

 

July 2011

State Medicaid Director Letter

States have an option to pursue either or both the Capitated or the Managed Fee-for-Service financial alignment models. In July 2011, CMS released a State Medicaid Directors' letter (PDF) to describe the two new options. As described in the letter, States interested in the new financial alignment opportunities were required to submit a letter of intent (LOI) by October 1, 2011.

  • Link to SMD Letter | PDF

 

Back to Top