Care Coordination Financing
Payment can promote care coordination by providers or by entities that work with providers and patients. For example, states can prospectively pay providers for coordinating care or hold providers accountable for costs that could be avoided by coordination.
*Milestone details:
*Full name: Identify opportunities to promote care coordination through reimbursement strategies used in Medicaid, CHIP, and state employee programs.
*Relevance to the ACA:
The ACA provides states with tools and potential funding to pilot and deploy new payment systems that reward providers for coordinating care. These reimbursement systems may take many forms, such as making care coordination codes billable, paying monthly care coordination fees, or tying payment to outcomes that are dependent on coordination with other providers. Many of the ACA provisions encouraging the use of medical homes and accountable care organizations offer states options for reimbursing for care coordination. Several additional opportunities are worth noting:
§2704 – Up to eight Medicaid programs to participate in bundled payment demonstration. The demonstration will emphasize hospital discharge planning.
§2705 – Up to five Medicaid programs to join global payment system demonstration.
§3021 – The mandate of the new Center for Medicare and Medicaid Innovation includes testing comprehensive payments to groups of providers.
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District of Columbia
Those interested in this topic may wish to see this recent announcement from CMS:
- Guidance on integrated care models: http://www.statereforum.org/discussions/care-coordination-financing#comm...
District of Columbia
CMS has released a "recipe book" for states interested in using Medicaid funds to promote integrated care. By integrated care, CMS refers to arrangements that are: "characterized by organized and accountable care delivery and payment methodologies aligned across payers and providers to ensure effective, seamless, and coordinated care." This pair of State Medicaid Director letters details the Medicaid authorities that states can use to develop and launch integrated care models.
Connecticut
The PCCM pilot program and PCMH final report address opportunities to promote care coordination through public program reimbursement strategies.
Minnesota
Minnesota has had an intergrated multi-payer health care home program in place since July 2010. We continue to add new health care homes every month. Enclosed is a copy of our State Plan Ammendment.
Minnesota
Medicare Payment for Health Care Home Services Set to Begin in October through Minnesota's participation in the Medicare Multi-payer Advanced Primary Care Practice (MAPCP) demonstration. Certified health care homes will be reimbursed for care coordination services provided to fee-for-service Medicare beneficiaries beginning 10/1/11. Health care home payment rates for Medicare have been approved by the federal Office of Management and Budget (OMB), clearing the final hurdle before the demonstration can be launched.
Implementation planning is well underway to equip Minnesota's contracted Medicare Part B carrier to process health care home claims. Detailed Medicare billing instructions for providers are available on the website. http://www.health.state.mn.us/healthreform/homes/medicare/index.html
I've also included our MAPCP application and our implementation memo to providers.
Oregon
The Oregon Legislature recently completed work on legislation to transform the way services are delivered and financed in the Oregon Health Plan, Oregon's Medicaid program. The attached bill, HB 3650, provides the basis for the Oregon Health Authority to craft new program elements guiding reform for Medicaid and dual-eligible individuals.
Maine
Care coordination is a key hallmark of the medical home model. Massachusetts has launched a multipayer medical home pilot that includes Medicaid. To learn more, please follow this link: http://www.statereforum.org/node/2206
Maine
Care coordination is a key hallmark of the medical home model. Maryland has launched a multipayer medical home pilot that includes commercial payers, Medicaid MCOs, and Medicare Advantage plans. To learn more, please follow this link http://www.statereforum.org/node/2206 and see slide 17 of this presentation http://mhcc.maryland.gov/pcmh/documents/SymposiumPresentationBethesda.pdf
Maine
A key component of the medical home model is a focus on care coordination. Diana Autin has shared information on New Jersey's effort to advance medical homes through Medicaid managed care here: http://www.statereforum.org/node/6125
District of Columbia
New Jersey’s contract with Medicaid managed care organizations (MCOs) specifies that the MCOs are to develop medical home demonstration projects. The contract specifies some basic requirements for the projects, and requires MCOs to seek state approval for their medical home payment methodologies. Further information is available in the contract at left and on NASHP's medical home map (http://www.nashp.org/med-home-states/new-jersey).
District of Columbia
New Jersey’s contract with Medicaid managed care organizations (MCOs) specifies that the MCOs are to develop medical home demonstration projects. The contract specifies some basic requirements for the projects, and requires MCOs to seek state approval for their medical home payment methodologies. Further information is available in the contract at left and on NASHP's medical home map (http://www.nashp.org/med-home-states/new-jersey).
Maine
Improving care coordination is a key purpose of primary care case management (PCCM) programs. Information on Rhode Island Medicaid's PCCM program, Connect Care Choice, is available online here: http://www.dhs.ri.gov/AdultswithDisabilities/HealthMedicalServices/Conne.... Pages 52-53 (58-59 of the PDF) of this report also discuss Connect Care Choice: http://www.statereforum.org/sites/default/files/healthy_ri_task_force_re....
Maine
Montana's Health Improvement Program helps coordinate care for targeted Medicaid and CHIP beneficiaries. To learn more about the Health Improvement Program, please visit this page:
http://www.statereforum.org/node/942
Maine
Community Care of North Carolina helps primary care practices function as medical homes. A key component of the Community Care model is an emphasis on excellent coordination across care settings. To learn more about Community Care, please visit: http://www.communitycarenc.com.
Community Care began by serving Medicaid beneficialness. Beneficiaries of a commercial payer are now included in the program in select counties. In addition, Community Care is serving Medicare beneficiaries through a 646 Quality Demonstration as well as the Medicare Advanced Primary Care Demonstration.
This presentation discusses the 646 Quality Demonstration: http://www.statereforum.org/sites/default/files/nc_communitycare.pdf
Maine
Those interested in this milestone may wish to view Pam Silberman's post available here: http://www.statereforum.org/node/6490#comment-8340
Maine
Care coordination is a key component of the medical home model. For more information on medical homes in New York, please see page 84 (page 75 of the PDF) of this report from the New York State Health Foundation: http://www.statereforum.org/sites/default/files/nyroadmappaper_aug2010.pdf
Maine
Those interested in this milestone may wish to see the post on New York's Adirondack Medical Home Demonstration here: http://www.statereforum.org/node/1545
as well as the post on New York's Health Home program here:
http://www.statereforum.org/node/1510
Maine
Those interested in this topic may wish to see Marilyn Kasmar's post on Alaska's Primary Care Innovation Strategic Plan here: http://www.statereforum.org/node/4579
Maine
The Administrator of the Idaho Division of Medicaid is a Co-chair of the Idaho Medical Home Collaborative. To learn more, please see M. Nelson's post here: http://www.statereforum.org/node/2572#comment-7025
Nebraska
Nebraska Medicaid Patient-Centered Medical Home two-year pilot began February 1, 2011 utilizing a payment methodology linked to the achievement of Minimum Standards and Advanced Standards.
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