CMS Announces New Coordinated Care Models for Dual Eligibles - July 12, 2011

The federal Centers for Medicare & Medicaid Services (CMS) recently announced it will test two new models aimed at coordinating the care provided to Medicare-Medicaid beneficiaries (dual eligibles). CMS will evaluate the two programs to determine whether they provide improved Medicare and Medicaid financing alignment and foster integration of higher-quality care. The first proposed model is a capitated model, in which the state, CMS and health plan enter into a three-way contract and the plan receives a prospective blended payment to provide care. The second model is a managed fee-for-service model, in which a state would be eligible for savings resulting from improved quality and reduced Medicare and Medicaid costs. Participation in the programs would last a maximum of three years. The new models are available to states already participating in the agency’s Demonstrations to Integrate Care for Dual Eligible Individuals, which began in April 2011, and any other state that proves that it can meet the standards and conditions of the new program. Interested states may submit a letter of intent to CMS. CMS has provided a State Medicaid Director letter providing more details of the program, including sample memoranda of understanding for both the capitated and fee-for-service models.