Promising practices

This policy brief provides a comparison of CMS’ finalized memoranda of understanding with California, Illinois, Massachusetts, Ohio, and Virginia to test a capitated model and with Washington to test a managed fee-for-service (FFS) model to integrate care and align financing for dual-eligibles. These 2013 demonstrations will introduce changes in the care delivery systems and will test a new system of payments and financing arrangements among CMS, the states and providers.

CMS created a financial alignment demonstration to better promote coordinated care for dual-eligibles. The fee-for-service managed care model has received less attention than capitated managed care. However, this model could be useful in states or regions where traditional managed care organizations are not well established or do not function well. This brief makes some assessments of the advantages and difficulties of the model and identifies elements necessary for successful implementation.

CMS has released two important documents that outline essential elements of MLTSS programs that are in line with current best practices. The first document summarizes these essential elements and the second provides guidance for incorporating these essential elements into MLTSS programs operating under section 1115 or 1915(b) authorities. These standards will be used when CMS reviews states’ design, implementation and operation of MLTSS programs for approval and ongoing quality assurance.

Money Follows the Person (MFP) federal grants are provided to states in order to assist older adults and people with disabilities in transitioning from nursing facilities to home and community based settings. A history and current state of MFP are offered. This report provides an overview of how MFP has helped states to rebalance their LTSS programs and provides next steps and an outlook for the future of MFP or similar programs once the demonstration project’s funding has run out.

The Affordable Care Act authorized the Medicaid Health Home State Plan Option, which allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States will receive enhanced federal funding to support the rollout of this new integrated model of care. This link directs to the Health Home Resource Center that provides technical assistance services for states as they submit their proposals for these health homes to CMS.

SAMHSA has updated its definition of recovery as it pertains to substance use and mental disorders. This working definition and set of guiding principles reflects the increased role peer supports and Peer Specialists have been playing in mental health programming. This document provides a summary of SAMHSA’s new definitions, as well as a checklist for effectively using peer supports in a variety of mental health programs.

What They Did. Did It Work? How They Did It and Adoption Considerations. These are all the questions that the Policy Innovations Profile will answer about Cash & Counseling. As a voluntary alternative to traditional agency-delivered home care, a joint public-private program gives Medicaid enrollees a monthly allowance for home care and related services that they can spend at their own discretion. Review the evidence. tools and resources and otherimplementation tips.

As increasing numbers of state Medicaid agencies implement both MFP and MLTSS programs, it is important to understand how they can work together to achieve common goals -- shifting the balance of LTSS from institutional care to HCBS settings. This report examines how 5 states have structured the interface between the two programs, including overlap in eligible groups, design of Medicaid payment rates to managed care organizations (MCOs); and how MFP and MCO staff share or divide responsibility.

Injuries are the third leading cause of death nationally, and the leading cause of death for Americans between the ages of 1 and 44. This report concludes that millions of injuries could be prevented each year if more states adopted additional research-based injury prevention policies, and if programs were fully implemented and enforced.

The Centers for Medicare and Medicaid Services (CMS) is currently working with states to design and implement new models for integrating the benefits and financing of both programs. This website is designed as a resource for advocates, providing resources, background information and, most importantly, in the Advocate Tools section, concrete recommendations that advocates need to engage constructively with their states to ensure that new models improve care for dual eligibles.