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  • Washington Highlights

    CMS Announces New Medicare-Medicaid Accountable Care Organization Model

    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.