The Integrated Care for Kids (InCK) Model is a child-centered local service delivery and state payment model aimed at reducing expenditures and improving the quality of care for children covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of priority health concerns like behavioral health challenges and physical health needs.
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Are integrated care programs evaluated effectively?
Our integrated care toolkit breaks down coverage options in an easy-to-understand format for counselors and consumers. Roughly 13 million Americans have both Medicare and Medicaid coverage. These individuals are often referred to as dual eligibles, or duals. Medicare covers most preventive and primary care services, as well as prescription drugs.
What can the new administration do for Integrated Care?
The Centers for Medicare & Medicaid Services (CMS) has several programs that encourage states to provide integrated care, a concept that provides the full array of Medicaid and Medicare benefits through a single delivery system in order to provide quality care for dual eligible enrollees, improve care coordination, and reduce administrative burdens.
Is there an integrated Medicaid and Medicare appeals process for special needs?
· the integrated care for kids (inck) model is a child-centered local service delivery and state payment model aimed at reducing expenditures and improving the quality of care for children covered by medicaid and the children’s health insurance program (chip) through prevention, early identification, and treatment of priority health concerns like …
What is the Integrated Care Framework?
· US government agencies, and the Medicaid program as part of the Centers for Medicare and Medicaid Services (CMS) in particular, have played a critical role in advancing integrated health and social care through policy and payment reform.
What is the goal of Medicare and Medicaid?
Advancing Care for People with Medicaid and Medicare Our goal is to make sure dually eligible individuals have full access to seamless, high quality health care and to make the system as cost-effective as possible.
What is an integrated Medicare plan?
The Centers for Medicare & Medicaid Services (CMS) has several programs that encourage states to provide integrated care, a concept that provides the full array of Medicaid and Medicare benefits through a single delivery system in order to provide quality care for dual eligible enrollees, improve care coordination, and ...
Is Medicare integrated?
Medicare beneficiaries could choose among the original Medicare program; Medicare Advantage; or a new option, Medicare Integrate. The key elements of original Medicare and Medicare Advantage are well known.
What does MMP mean in Medicare?
Medicare-Medicaid PlanMedicare-Medicaid Coordination Office. Information and Guidance for Plans. Medicare-Medicaid Plan (MMP) Enrollment.
Resources and Products
RIC offers a collection of resources and products for stakeholders to review and download. Briefs, client handouts, concept guides, learning collaboratives, tip sheets, assessment tools, podcasts, videos and webinars are all available for providers, provider groups, health plans, health systems, caregivers, members and other stakeholders.
Topic Areas of Focus
RIC works with multiple stakeholders to identify promising practices to improve the coordination of care for Medicare-Medicaid enrollees. These promising practices are based on five core concepts which were derived from an in-depth analysis of the Medicare-Medicaid beneficiary population and are listed as links to the right.
Webinars and Podcasts
Please check the RIC website to review past webinars and podcasts. All past webinars can be viewed in their entirety and CMS credits may be available. Please check the RIC events calendar for upcoming times, dates and registration information.
Available Tools
Meeting the needs of persons with disabilities is of increasing importance as individuals live longer and the prevalence of adults with functional limitations and disabilities rises.
When will the Integrated Care for Kids model start?
The Integrated Care for Kids Model is expected to begin in early 2020 with a two-year pre-implementation period in which CMS will work with states and Lead Organizations to assist the states in establishing or modifying any needed Medicaid and CHIP authorities and provide technical assistance to develop the infrastructure and procedures necessary for model implementation. A five-year model implementation period will follow in which states and Lead Organizations will implement their models and report required data to CMS.
How many states are in the Medicaid model?
State Medicaid agencies will participate in the model regardless of whether they also serve as the Lead Organization. CMS will award up to 8 states. Either a State Medicaid Agency or a Lead Organization will be the awardee of a cooperative agreement.
How is Inck funding awarded?
InCK Model funding will be awarded via cooperative agreement. CMS has released a Notice of Funding Opportunity (NOFO) to solicit applications for up to eight cooperative agreements under the InCK model. Each cooperative agreement will be up to $16 million for the seven-year model period. Applicants will need to explain how they will use existing funding sources to deliver services to beneficiaries because model funding may be used only to support model planning and implementation activities. The state Medicaid agency and Lead Organization will partner together to write the application, but only one of these entities will be considered the applicant and the model awardee. The NOFO explains additional model and application requirements, as well as awardee eligibility criteria.
What is the Inck service integration structure?
The InCK service integration structure is based on population-wide risk-stratification according to level of need. Service Integration Levels (SILs) consist of integrated care coordination and case management levels of increasing intensity appropriate for individual needs. The goal of stratification is to ensure that children receive the individualized care they need in the most integrated and least restrictive setting appropriate.
Who is the key participant in the Inck model?
The key participants of the InCK Model will be the state Medicaid agency and a local entity called a “Lead Organization.”
What is a health plan access to claims and encounter data?
Health plan access to claims and encounter data for new enrollees to identify high-risk enrollees and provide prompt assessments, including a standard functional assessment tool, a single primary care provider, and an interdisciplinary care team to develop an individualized person-centered care plan that is designed to meet the unique needs of high-risk enrollees; the care plan should include primary, specialty, acute and post-acute care, and pharmacy services. The care plan should be updated as needed to address beneficiaries needs as they change over time and across care settings
What is a single and streamlined set of measures across the two programs?
A single and streamlined set of measures across the two programs, including a set of quality measures and performance evaluations developed for complex populations, to be used for quality improvement and to serve as a basis for quality reporting to help beneficiary decision-making
What is LTSS in Medicare?
Services – All Medicare and Medicaid-covered benefits offered by an improved FIDE SNP should be offered as a single benefit package that includes medical services, behavioral health services, and long-term services and supports (LTSS). LTSS benefits would be available to eligible individuals meeting the Health Insurance Portability and Accountability Act of 1996 standard of a deficit of two or more activities of daily living (ADLs) or a need for supervision as a result of cognitive impairment.
What is a federal fallback program?
Federal Fallback Program for States that Do Not Integrate Care. A federal fallback program is critical to a well-functioning program of Medicare and Medicaid integration. The following section provides a general framework for the fallback, if states are not able or willing to implement an integrated solution.
What is BPC in healthcare?
BPC is one of a small but growing group ...
Does each model cover Medicare and Medicaid?
Each model must cover all Medicare and Medicaid benefits and meet all integration requirements identified in this report. These recommendations are intended to build on best practices of the past 40 years in integrating care for full-benefit dual eligible individuals.
What states does IAP help?
IAP provided technical assistance to the District of Columbia, New Jersey, Oregon, Texas, and Virginia related to BCNs. These technical assistance activities, which ran from October 2015 through August 2016, aimed to help states enhance state capacity to use data analytics to better serve beneficiaries, develop/refine payment reforms ...
What is the IAP program?
As part of this program area, IAP provided technical assistance to two groups of states.
Which states are in the second IAP PMH?
In the second IAP PMH integration group, Nevada, New Hampshire, New Jersey, Puerto Rico, and Washington received coaching and technical assistance based on individual state needs. Additional information about the technical assistance provided can be found in the Medicaid IAP PMH Factsheet(PDF, 121.69 KB).
What is CMS interested in?
CMS is interested in testing alternative payment arrangements that promote value over volume, include financial accountability, and are projected by CMS to generate Medicare savings. For all practices, shared savings will be calculated at the market level– not the individual practice level—based on Medicare Parts A and B expenditures. Given the small numbers of patients associated with individual practices, we do not feel we can accurately calculate savings at the practice level and plan instead to do it at the market level.
What is Medicare beneficiary alignment?
The Medicare beneficiary alignment informs the amount of care management fees paid to practices each month as well as the shared savings calculation. Beneficiaries will be aligned with the practice of primary care providers who billed for the plurality of their primary care allowed charges during the most recent 24-month period. If a beneficiary has an equal number of qualifying visits to more than one practice, the beneficiary will be assigned to the practice with the most recent visit.
What is the purpose of the Innovation Center?
The Innovation Center will monitor primary care practices participating in this initiative to ensure that access to care is not being compromised, that practices are either building or have built the capacity and infrastructure to deliver comprehensive primary care, and that the Innovation Center is receiving data from practices demonstrating their engagement in continuous improvement. To safeguard against reductions of necessary care, the Innovation Center will routinely analyze comparative data on Medicare service utilization, and will investigate Medicare utilization patterns which may include comparison surveys of beneficiaries aligned with the primary care practice and those in the general beneficiary population, medical record audits, or other means. Additionally, the Innovation Center will conduct a baseline CAHPS survey to evaluate aligned patients’ experience of care; this will be repeated two years into the initiative. The Innovation Center will also determine whether there are systematic differences in health status or other characteristics between Medicare patients who remain aligned with a given primary care practice over the course of the initiative, and those who do not.
Who will provide cost and utilization data to primary care practices?
All participating payers and the Innovation Center will provide cost and utilization data to primary care practices selected for this initiative. Medicare beneficiaries will be notified that their data is being shared with their primary care practice.
What is collaborative payers?
Collaborating payers will work with the Innovation Center to develop coordinated, enhanced support within defined markets for comprehensive primary care functions aimed at reducing total health system costs while achieving better health and
What is the Innovation Center approach?
Innovation Center approach: The Innovation Center is proposing to use a prospective alignment methodology to identify the population of Medicare fee-for-service beneficiaries for whom primary care practices within a market are accountable for care and costs in this initiative. See Section F for details.
What is comprehensive primary care?
The Comprehensive Primary Care initiative extends and builds upon the patient-centered medical home concept (as defined in the Joint Principles of the Patient-Centered Medical Home, by ACP/AAFP/AAP/AAOP, by the NCQA and others) to include payment reform to support practice transformation, an explicit focus on accountability for total cost of care with data to support care improvement and efficiency, and a requirement that all practices have an electronic health record system or electronic registry. Preference will be given to practices that have achieved stage 1 meaningful use of certified EHRs as defined by the Health Information Technology for Economic and Clinical Health (HITECH) Act. We are testing whether these additional drivers can deliver lower total costs through improvement for Medicare and Medicaid when implemented with the support of payer collaborations that comprise the majority of a practice’s revenue. Having a majority of a practice’s payers supporting enhanced primary care will ensure that a practice can implement a more consistent and comprehensive approach to treating patients. Without that majority, practices risk not having enough sustained support to provide the services we are seeking, and our investment – if not coordinated with other payers – will not be as likely to generate savings or improved services for beneficiaries.
Resources and Products
Topic Areas of Focus
- RIC works with multiple stakeholders to identify promising practices to improve the coordination of care for Medicare-Medicaid enrollees. These promising practices are based on five core concepts which were derived from an in-depth analysis of the Medicare-Medicaid beneficiary population and are listed as links to the right. Tools and resources bas...
Webinars and Podcasts
- Please check the RIC website to review past webinars and podcasts. All past webinars can be viewed in their entirety and CMS credits may be available. Please check the RIC events calendarfor upcoming times, dates and registration information.
Available Tools
- Disability Competent Care Assessment Tool
https://www.resourcesforintegratedcare.com/DCC_Self-Assessment_Tool Meeting the needs of persons with disabilities is of increasing importance as individuals live longer and the prevalence of adults with functional limitations and disabilities rises. The Disability Competent Care Assess… - Geriatric-Competent Care - Geriatric Services Capacity Assessment Tool
https://resourcesforintegratedcare.com/Older_Adults/GCC/Tool/Care_For_Geriatric_Consumers The Geriatric Services Capacity Assessment Tool was developed to help health plans and health systems, including community providers, hospitals, and other health care delivery organizations, …
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II. Enrollment and Eligibility
III. State-Administered Integration of Care
- To encourage states to integrate Medicare and Medicaid for dual eligible individuals, Congress should: A. Define and develop fully integrated models for states that choose to integrate care.States would choose from three models meeting the definition of “full integration”” defined above: (1) improved FIDE SNP, (2) PACE, and (3) a flexible model neg...
IV. Federal Fallback Program For States That Do Not Integrate Care
- A federal fallback program is critical to a well-functioning program of Medicare and Medicaid integration. The following section provides a general framework for the fallback, if states are not able or willing to implement an integrated solution. BPC plans to fully explore the critical details of the federal fallback— including eligibility, benefits, consumer protections, reimbursement, contra…
v. Improving Beneficiary Experience
- To ensure beneficiaries have a seamless experience in integrated care models, Congress should: A. Direct the secretary of HHS to require collaboration between CMS, the Administration for Community Living, and states to implement model standards for outreach and education, and increase funding to the State Health Insurance Assistance Program to expand and improve infor…