Financial Alignment Demonstrations for Dual Eligible Beneficiaries: A Look at CMS’s Evaluation Plan

Introduction

1. For more information about the demonstrations, see Kaiser Commission on Medicaid and the Uninsured, Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared:  States with Memoranda of Understanding Approved by CMS (May 2014), available at https://www.kff.org/medicaid/issue-brief/financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/.

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2. See RTI International, Measurement, Monitoring, and Evaluation of State Demonstrations to Integration Care for Dual Eligible Individuals, Aggregate Evaluation Plan (Dec. 16, 2013), available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Evaluations.html.

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3. For example, Massachusetts has released preliminary findings from focus groups with beneficiaries who voluntarily enrolled in the demonstration and who opted out of the demonstration.  Mass. Executive Office of Health and Human Services, One Care Early Indicator Project Reports, available at http://www.mass.gov/eohhs/consumer/insurance/one-care/one-care-early-indicators-project-eip-reports.html.

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4. As of the writing of this issue brief, RTI’s state-specific evaluation plans are available online for Massachusetts (Dec. 23, 2013), Ohio (Jan. 3, 2014), Virginia (April 24, 2014), Illinois (April 28, 2014), and Washington’s managed FFS (May 13, 2014) and capitated (June 3, 2014) models.  See http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Evaluations.html.    

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Issue Brief

1. ACA § 3021(a), adding 42 U.S.C. § 1315a(b)(4)(A).

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2. Id. adding 42 U.S.C. § 1315a(b)(4)(B).

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3. Id. adding 42 U.S.C. § 1315a(b)(4)(C).

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4. Id. adding 42 U.S.C. § 1315a(b)(4)(B).

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5. For more detail, see RTI International, Measurement, Monitoring, and Evaluation of State Demonstrations to Integration Care for Dual Eligible Individuals, Aggregate Evaluation Plan, Table 18, Quality measures for evaluation:  Detailed definitions, use and specifications (Dec. 16, 2013), available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Evaluations.html

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6. By contrast, an actuarial approach will be used to determine cost savings in managed FFS states, which can be calculated on a faster timeline to determine the performance payments to states after the end of each demonstration year.

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