New section

Content Background

New section

CMS Announces New Medicare-Medicaid Accountable Care Organization Model

December 16, 2016

New section

New section

PRESS CONTACTS
Mary Mullaney, Director, Hospital Payment Policies

The Centers for Medicare and Medicaid Services (CMS) Dec. 15 announced the Medicare-Medicaid Accountable Care Organization (ACO) Model, which aims to improve care coordination for beneficiaries who are enrolled in both Medicare and Medicaid, otherwise known as dual-eligibles.

The new ACO model builds on the current Medicare Shared Savings Program (MSSP). In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. The Medicare-Medicaid ACO Model will allow MSSP ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.

CMS is accepting letters of intent from states that wish to work with CMS to design certain state-specific elements of the model. The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid.

Additionally, CMS will enter into participation agreements with up to six states with preference given to states that have low Medicare ACO saturation. Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.

New section