Staff from the American Health Care Association (AHCA) arranged for a conference call on September 7 for the 15 states with integrated care contracts for dual eligibles (meaning persons eligible for both Medicare and Medicaid). Since Minnesota is one of these states, Association staff participated in the call. Tim Englehardt from the Medicare-Medicaid Coordination Office at the Center for Medicare and Medicaid Services (CMS) joined us for this call. Here are some of the “tidbits” from this conversation, which gave us a much clearer perspective on both the dual eligible grants as well as a related demonstration announced in July:

• The primary objective of the 15 state dual eligible contracts is to get more dual eligible persons into an organized system of care. Of the nine million estimated to be dually-eligible in the U.S., only an estimated 150,000 are receiving integrated care.
• The 15 states each have received $1 million to plan integrated care cutting across acute/long-term/behavioral care. 40% of the dual eligible population is under age 65, with a significant percentage including persons with mental illness. The 15 states that were chosen were selected because they were the “most ready” and would be able to implement what they planned in 2012.
• There are certain expectations CMS has for all 15 of the states:
• the planning must include a public, open and transparent design process that involves stakeholders;
• the model they develop must include a full set of benefits; and
• they must be able to implement the program before the end of 2012. (The implementation plan itself is due by April 2012.)
• CMS will make new flexibility available to participating states in concert with the CMS Innovations Center (who has the Medicare waiver authority).

On a parallel track, the Center sent a letter in July to all Medicaid directors announcing new alignment models that will be available for all states, but which are specifically made available for the 15 demonstration states. The new models are intended to change the “business case” in which states would be able to share in a portion of the Medicare savings that resulted from the new delivery model. A letter of intent to participate in these models is due by October 1, 2011 (Minnesota intends to submit one); however, states will not be held to the specific content at this early date. CMS has the same expectation about stakeholder engagement with these new alignment models as they have with the dual eligible demonstration.

As a reminder, information on the integrated care program for duals is on AHCA’s website here.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

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