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

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

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.

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

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.

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

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

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

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.

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.  

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.

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

Medicare-Medicaid Coordination Office More Information Medicare-Medicaid Coordination Office www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/ Medicare-MedicaidCoordination@cms.hhs.gov