CMS, Rhode Island Announce New Medicare-Medicaid Care Model
By - The Centers for Medicare & Medicaid Services (CMS) announced a partnering with the state of Rhode Island last Thursday to test a new model for supporting Medicare-Medicaid enrollees by advocating for a more harmoniously executed, people-focused care experience.
This collaborative initiative allows for statewide benefit integration. Almost 30,000 Medicare-Medicaid enrollees within the state of Rhode Island are eligible for a demonstration that will allow both CMS and the state to deliver unified Medicare and Medicaid benefits to those enrolled.
Such an initiative follows CMS’s 2001 announcement offering states a partnership opportunity through either a managed fee-for-service model or the capitated model Rhode Island will be utilizing.
The demonstration serves as an expansion of sorts of Rhode Island’s currently implemented Integrated Care Initiative where the Rhody Health Options (RHO) Medicaid managed care program was established. Under RHO, Medicare-Medicaid enrollees and Medicaid members enroll in a coordinated Medicaid plan. Under the newly announced Rhode Island/CMS demonstration, contracted and qualified RHO plans will serve as Medicare-Medicaid Plans (MMPs), covering both Medicare benefits and current Medicaid benefits.
A dedicated service team, says CMS, will be available to help enrollees address three specific needs – medical health, behavioral health, and long-term services/supports needs.
CMS outlines demonstration focus, confirms support
According to CMS, putting the beneficiary first is key. CMS explains the following trifold effort to help execute this objective:
- Care Coordination: Under the demonstration, care coordination services will be available to all enrollees. The participating MMP will offer a service coordination team to ensure the integration of the enrollee’s medical, behavioral health, long-term services and supports, and social needs. The team will be built on the enrollee’s specific preferences and goals.
- Quality Measures: The new demonstration includes beneficiary protections to ensure that enrollees receive high-quality care. CMS and Rhode Island have established quality measures relating to the beneficiary’s overall experience, care coordination, and fostering and supporting community living, among many others.
- Other Protections: The demonstration also includes continuity of care requirements to ensure that enrollees can continue to see their current providers during their transitions into the MMP. The Rhode Island Ombudsman program will support individual advocacy and provide Rhode Island and CMS with feedback on plan performance for the demonstration, with a focus on compliance with principles of community integration, independent living, and person-centered care.
CMS confirms its priority of “[improving] the care experience for low-income seniors and people with disabilities who are Medicare-Medicaid enrollees.” Says CMS, because many Medicare-Medicaid enrollees experience severe chronic conditions, better care coordination and management of long-term services and supports will help enrollees better navigate their benefits, insurance cards, and healthcare providers.
Says CMS, “Through the demonstrations approved under the Financial Alignment Initiative, CMS seeks to provide Medicare-Medicaid enrollees with a better care experience by offering a person-centered, integrated care initiative that provides a more easily navigable and seamless path to all covered Medicare and Medicaid services.”
CMS additionally confirms its support for the assimilation of healthcare benefits. “We are pleased to partner with Rhode Island to bring more person-centered care to Medicare-Medicaid enrollees,” says Andy Slavitt, CMS Acting Administrator. “We look forward to working together to provide beneficiaries with an opportunity to experience more integrated benefits."
