January 25, 2012

CMS Guidance for Organizations Interested in Offering Capitated Financial Alignment Demonstration Plans

Through the Center for Medicare & Medicaid Innovation (the Innovation Center), CMS will test two financial alignment models with States across the country – a capitated approach and a managed fee-for-service approach. The capitated model that will use health plans or other qualified entities for delivery of medical, behavioral health, and long-term services and supports is the subject of the information in this guidance. Under these demonstrations, CMS, the state, and health plans or other qualified entities will enter into a three-way contract. The finalization of each contract will follow a joint plan selection process by CMS and each participating state. The three-way contracts will test administrative, benefit and enrollment flexibilities that will further the goal of providing a seamless experience for Medicare-Medicaid enrollees by utilizing a simplified and unified set of rules and an integrated payment model.