IMS submits comments on dual eligible demonstration project
May 15, 2012
IMS has submitted formal comments as part of the public input period for Iowa Medicaid's Financial Alignment Demonstration Proposal for Medicare-Medicaid Members. As we first reported in the April 20, 2012 IMS Advocate, this proposal is in response to efforts by CMS to address the spiraling cost of caring for dually eligible Medicare-Medicaid beneficiaries. In July of 2011, CMS offered state Medicaid programs the option of participating in demonstration projects to better align financial efforts for the two programs. Iowa was among 37 states and the District of Columbia to submit a letter of intent to participate in the project. Participating states were given the option of pursing a Capitated Model or a Managed Fee-For-Service Model; Iowa Medicaid Enterprise (IME) selected the Managed Fee-For-Service Model.
The Iowa demonstration proposal encompasses five components, which seek to reduce expenses by better coordinating the care provided to dual eligibles. With the exception of the Health Homes piece which IME is planning to implement beginning on July 1, 2012, this project is scheduled to begin January 1, 2013. The program components are as follows:
- Build upon the work of the Medical Home System Advisory Council by establishing Health Homes statewide. Since July of last year, IME has operated a pilot program of five Integrated Health Homes which coordinate the care for adults with Serious and Persistent Mental Illness. IME has submitted a State Plan Amendment to CMS, and is proposing to offer this alternative care option to all Medicaid members, including dual eligibles, who meet chronic condition eligibility criteria. Iowa Medicaid will provide Per Member Per Month care coordination payments in addition to existing fee-for-service payments, and consider utilizing a Health Home practice facilitation model to assist providers with transitioning to offering these services.
- Expand the current Medicaid Value Management program to incorporate Medicare Parts A, B, and D data. IME is hoping that by incorporating this Medicare data, it will be able to better identify points in care delivery that can be improved.
- Implement a Balancing Incentives Payment Program (BIPP) for Long-Term Supports and Services received in home and community-based settings. As part of the BIPP program, IME seeks to decrease the number of individuals who receive care in institutional settings and improve overall system infrastructure.
- Expand current Medicaid Disease Management programs to provide services such telephonic health coaches to dual eligible patients not in a Health Home, eventually transitioning those services into Health Homes. As part of this expansion, Medicaid also proposes to expand the Member Lock-In program which restricts the number of providers an individual is able to see when suspected of abusing medical services and prescription drugs.
- Collaborate with Accountable Care Organizations (ACOs) currently under development, including the TriHealth Pioneer ACO in Fort Dodge, to explore care coordination options for dual eligible patients.