The federal government has introduced a new accountable care organization model aimed at working with states to provide better quality, lower cost care for people enrolled in both Medicare and Medicaid.
Under the Medicare-Medicaid ACO Model, ACOs in the Medicare Shared Savings Program (MSSP) will be accountable for both Medicare and Medicaid costs and quality for dual-eligible enrollees, according to the Centers for Medicare & Medicaid Services.
The goal is also to improve care coordination for dual-eligibles, “allowing providers to focus more on providing care for their patients rather than administrative work,” CMS Acting Principal Deputy Administrator Patrick Conway said in the announcement.
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States are already innovating in this space, according to a CMS report released in January. It highlighted the early successes of the Washington Health Homes demonstration, which aims to streamline the financing of Medicare and Medicaid while integrating services for dual-eligible enrollees. A final rule released in June also sought to increase care coordination in MSSP ACOs by factoring their performance relative to other local providers into reimbursements.
CMS is currently accepting letters of intent from states that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. Giving preference to states with low Medicare ACO saturation, CMS will approve up to six states to help design “certain state-specific elements of the model.”
States can choose to start the first yearlong performance period for the new ACOs to begin in either 2018, 2019 or 2020. If Medicare-Medicaid ACOs generate Medicare savings for their dual-eligible enrollees, both states and the ACO may be eligible to share in those savings with CMS, according to a CMS fact sheet.
In addition, Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.