South Carolina Signs Memorandum of Understanding with CMS - Becoming the Eighth State to Adopt Medicare-Medicaid Dual Eligibles Initiative
The National Council on Medicaid Home Care – a NAHC Affiliate – Issues In-Depth Issue Brief on the South Carolina Program
November 21, 2013 10:59 AM
On October 25, 2013, the Centers for Medicare and Medicaid Services (CMS) and the South Carolina Department of Health and Human Services (SCDHHS) signed a Memorandum of Understanding (MOU) establishing the Medicare-Medicaid Alignment Initiative (MMAI) in South Carolina (the Demonstration). South Carolina is now the eighth state to implement the MMAI, after Massachusetts, Washington, Ohio, Illinois, California, Virginia, and New York.
Fifteen other states have active proposals submitted to CMS. The MMAI is a joint federal and state project that seeks to improve care and reduce costs associated with beneficiaries eligible for both Medicare and Medicaid, or “dual eligibles.” Minnesota has signed a dual eligibles demonstration independent of the MMAI.
In South Carolina, the Demonstration is called the Health Connections Prime program. It functions to enroll dual eligibles into managed care plans called Coordinated and Integrated Care Organizations (CICOs), and provide long-term care services and supports (LTSS). Starting no earlier than July 1, 2014, the Demonstration will eventually coordinate care to approximately 54,000 dual eligibles and encompass all counties of the state.
The MOU and its appendices “are not intended to create contractual or other legal rights between the parties,” so details will be provided in future three way contracts between CMS, SCDHHS, and the CICOs.
Overview of the Demonstration
The Demonstration will begin no earlier than July 1, 2014, and continue until December 31, 2017. South Carolina has opted for a capitation model, where CMS, SCDHHS, and the CICOs enter into three-way contracts in which each plan receives a prospective blended Medicare/Medicaid payment to provide coordinated and comprehensive care. SCDHHS will provide the CICOs the Medicaid component of the rate, while CMS will provide payments for Medicare Parts A, B, and D. CICOs may subcontract services.
Key objectives for the Demonstration include independent living and self-direction to foster improved quality of care and care transitions, fewer health disparities, reduced costs to CMS and SCDHHS, and the end of cost-shifting between Medicare and Medicaid. The Demonstration also creates a great opportunity for home care as it prioritizes re-balancing of care towards community-based systems and away from the institutional setting, in a “phased transition of roles and responsibilities of home and community based service (HCBS) [from the state] to the CICOs.” This phased transition will be discussed further below.
The Demonstration will focus on shifting LTSS from the institutional setting to a home and community-based setting. Specifically, CICOs must give Participants benefits “in a care setting appropriate to [their] needs, with a preference for the home and the community…in the least restrictive and most integrated home and community setting, and in accordance with the Enrollee’s wishes and Individualized Care Plan.”
To view the National Council on Medicaid Home Care’s full Issue Brief, please click here.