CMS Unveils Medicare-Medicaid ACO Model

A Medicare-Medicaid accountable care organization (ACO) model has been recently disclosed by CMS (Centers for Medicare and Medicaid Services) that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid charges and quality of care for dual-eligible beneficiaries.

The Medicare-Medicaid accountable care organization model will develop on the current Medicare Shared Savings Program. CMS plans to establish state-specific Medicaid financial accountability techniques and shared savings and losses arrangements in regard to conjunction with states.
Each state model will also have its own extra quality measures and accountable care organization eligibility requirements.
Patrick Conway, MD, CMS Acting Principal Deputy Administrator said, “This model targets to offer improved care coordination for those enrolled in both Medicare and Medicaid, permitting providers to concentrate more on providing care for their sufferers instead of administrative work. CMS sustains to partner with and leverage the best ideas from states to change our healthcare system to make better quality and care coordination. In the long run, this partnership will outcome in healthier people and smarter spending.”
The 433 ACOs has been included by the Medicare Shared Savings Programs that covered almost 7.7 million assigned Medicare beneficiaries as of the month April 2016. Although, the Medicare accountable care organizations didn’t have financial accountability for Medicaid spending and quality of care, even for dual-eligible beneficiaries assigned to their agency.
CMS created the newest ACO model to add Medicaid accountability to existing Medicare Shared Savings Program ACOs in order to reduce the healthcare charges related to dual0eligible beneficiaries. Participants in the dual-eligible-specific model will conduct financial and quality of care responsibility for beneficiaries in the field of Medicare Part A, Medicare B, and Medicaid.
Without Medicaid accountability, CMS reported in the month of August that Medicare Shared Savings Program ACOs provided over $429 million in savings in the year of 2015, with 119 ACOs getting shared savings payments.
Care quality was also improved by the Medicare ACOs. The average quality performance rose by over 15% between the time period of 2014 and 2015 in 4 measures, involving risk of future falls screening, depression screening and follow-up, blood pressure screening and follow-up, and pneumonia vaccinations.
CMS proposed to bring the similar cost reductions and quality improvements to the dual-eligible population  by adding the Medicaid accountability.
The Medicare-Medicaid ACO model was also designed by CMS to promote alternative payment model participation among safety-net providers who tend to care for more dual-eligible beneficiaries. Safety-net ACOs will qualify to get prospective Medicare shared savings payments to foster care coordination investments under the supervision of model.
The Medicare-Medicaid ACOs with interested states will be developed by the federal agency. States can gain shared savings payments through the model if their Medicare-Medicaid ACOs produce Medicare savings for their dual-eligible enrollees. The ACOs will also share in the payments.
States that have an important number of dual-eligible beneficiaries in Medicare and Medicaid fee-for-service can apply to participate. Although, only 6 states will be selected by CMS with preference given to states with low Medicare ACO saturation.
Selected states will work with CMS to develop state-specific ACO model elements, like Medicaid costs methodology, payment arrangements, and quality measures. States will also be capable to involve extra Medicare-Medicaid enrollees not assigned to the Shared Savings Program and/or Medicaid-only beneficiaries in the model.
States must submit a letter of intent to CMS by the day of Jan. 20, 2017 in order To participate in the first twelve-month performance period in the year of 2018.
States can submit a letter of intent for 2019 participation by the day of Aug. 4, 2017 and for 2020 participation by the day of Aug. 3, 2018 for future participation.