Center for Medicare and Medicaid Innovation

The Affordable Care Act has created within Centers for Medicare & Medicaid Services (“CMS”) a new Center for Medicare and Medicaid Innovation (“CMMI”).  The purpose of CMMI is to develop and test innovative payment and delivery system models designed to encourage coordinated care in Medicare, Medicaid and CHIP.  $10 Billion has been appropriated for 2011 through 2019.  CMMI must be operational by January 1, 2011 and pilot programs and demonstration projects are expected to begin in early 2011. 

On November 10, 2010, CMMI launched its Web site, www.innovations.cms.gov, which contains information relating to a series of open forum calls and in-person regional community listening sessions that are open to the public and will be hosted by Richard Gilfillan, M.D., the Acting Director of CMMI. These sessions are intended to help CMMI obtain input regarding its goals, operating plans and priorities.

Healthcare providers and businesses engaged in the healthcare industry should participate in these sessions, prepare to respond to upcoming CMMI requests for proposals, and start getting ready to develop proposals for CMMI to consider funding. You can sign up for CMMI e-mail updates on the Innovations Center Web site.

In conjunction with the launch of CMMI, CMS also announced four new initiatives designed to promote care coordination among providers:

• Expansion of the Multi-Payer Advanced Primary Care Practice Demonstration: Eight states, including New York, have been selected to participate in a demonstration project to evaluate the effectiveness of doctors and other health professionals across the care system working in a more integrated fashion and receiving payment from Medicare, Medicaid, and private health plans.
• Announcement of the Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration: This demonstration will test the effectiveness of doctors and other health professionals working in teams to treat low-income patients at community health centers. The demonstration will be conducted by the Innovation Center in up to 500 FQHCs and provide patient-centered, coordinated care to approximately 195,000 people with Medicare.
• Launch of the Medicaid Health Home State Plan Option: Authorized by the Affordable Care Act, this new State plan option allows patients enrolled in Medicaid with at least two chronic conditions to designate a provider as a “health home” to help coordinate treatments for the patient. States that implement this option will receive enhanced financial resources from the federal government to support “health homes” in their Medicaid programs.
• A Dual Eligible Demonstration Project in Up to 15 States: The Innovation Center also announced an upcoming opportunity for demonstration projects that will examine programs that fully integrate care for individuals who are eligible for both Medicare and Medicaid (i.e., dual eligibles). Dual eligibles account for 16 to 18 percent of enrollees in Medicare and Medicaid, but roughly 25 to 45 percent of spending in these programs respectively. Significant health benefits and savings can come from better coordinating the care of low-income seniors and people with disabilities. States may apply for resources to support the demonstration projects they design beginning in December and the Innovation Center will award up to 15 state program design contracts up to $1 million each. In 2011, the Center will be announcing two additional demonstrations that will focus respectively on providers and beneficiaries.