Section VI. Federal and State Policy Guidance
States and the federal government have addressed issues surrounding the development of Medicaid ACO programs through policy papers, regulations, and contracting practices. This section contains a variety of documents including state contracts, CMS guidance, and requests for proposals from states and the federal government.
Next Generation ACO Request for Applications (Updated March 2016) – In 2015, CMS developed a new ACO program for Medicare with a more ambitious risk sharing schedule and revised benchmarking standards. While issued for the Medicare population, states can use this guidance from CMS to develop Medicaid programs or align their programs with the emerging model.
Federal Managed Care Final Rule (April 2016) – CMS recently released its Medicaid Managed Care Final Rule. The Final Rule is designed to align state managed care programs with other payers and supports states considering delivery system reform. A variety of fact sheets are also available to help explain the rule.
CMS’s Core Quality Measures (February 2016) The Core Quality Measure Collaborative developed this set of measures — including ACO related measures — that are designed to align quality measurement across commercial and government payers.
State Medicaid Director Letter on Shared Savings (August 2013) – SMDL #13-005 outlines formal guidance from CMS on the implementation of shared savings programs in state Medicaid programs. The letter explains the approach and lists important regulatory concerns for states considering the approach.
CMS State Medicaid Director Letter 12-001 – Integrated Care Models (July 2012) – This CMS letter to State Medicaid Directors lays out integrated models of care (including ACOs) that states might consider implementing to achieve better care, better health, and reduced expenditures in Medicaid programs.
Colorado Accountable Care Collaborative Phase II (May 2017) – This RFP provides details on the next iteration of Colorado’s Regional Care Collaborative Organizations. The 2017 program will build on its existing program and integrates physical and behavioral health under geographically-assigned accountable entities.
District of Columbia: Request for Information on Potential Medicaid ACOs (April 2017) – This RFI seeks feedback from health plans, providers, hospitals, consumers, and advocates regarding the potential establishment of a Medicaid ACO program in the District. Responses will be used to develop a proposed approach to the ACO program design.
Minnesota’s Integrated Health Partnerships 2.0 (May 2017) – This RFP provides details on the next iteration of Minnesota’s Integrated Health Partnerships (IHP) program. The new model but goes further in encouraging partnerships between IHPs and community resources to address patients’ social determinants of health.
The New Jersey Medicaid ACO Demonstration: Assessment of Operations and Care Management Strategies (February 2017) – This Rutgers Center for State Health Policy report discusses how the state’s three certified ACOs have approached the first year of operations and the kinds of care management strategies they plan to implement in the near future.
The New Jersey Medicaid ACO Demonstration: Lessons from the Implementation Process (June 2016) –This report from the Rutgers Center for State Health Policy shares stakeholder views on the early implementation of the New Jersey Medicaid ACO demonstration. It also distills lessons for states, payers, and providers interested in designing Medicaid ACO programs.
2016 Vermont Medicaid Shared Savings Program RFP (April 2016) – The 2016 iteration of the Vermont MSSP program builds on the Next Generation ACO model in providing prospective payment and attribution to participating contractors. These documents provide a good example of how one state adapted the Next Generation ACO model for its particular Medicaid needs.
Minnesota MCO Contract (November 2015) – Minnesota’s Department of Human Services managed care organization (MCO) contract contains language that requires MCOs to work with Integrated Health Partnerships — Minnesota’s Medicaid ACOs — and delineates the responsibilities between those two entities and the state. The most relevant language is on pages 83-85.
Rhode Island Accountable Entity Coordinated Care Pilot Application (October 2015) – In late 2015, Rhode Island issued an RFA for its new Accountable Entity (AE) pilot program. This document provides an overview of the program, including the qualifications for an entity to serve as an AE.
Maine State Plan Amendment (SPA) (July 2014) – Maine’s Accountable Communities (AC) program is integrated with the state’s patient-centered medical home, health home, and community care team programs. Section 3 of Maine’s state plan amendment focuses on the ACs’ networks and required partnerships among chronic care, developmental disabilities, and behavioral health providers.
New Jersey Medicaid ACO Shared Savings Methodology (July 2012) – New Jersey’s Medicaid ACO program targets beneficiaries with complex medical and social needs who contribute to the state’s high utilization of health care services. Rutgers, the State University of New Jersey, developed this proposed shared savings methodology to target high-need, high-cost patients.
Oregon’s Coordinated Care Organization Request for Applications (RFA) (March 2012) – Oregon’s Coordinated Care Organizations are geographically-based Medicaid ACOs that operate under a global budget. This request for applications establishes requirements for entities interesting as serving as a regional care organization.