CMS Details Provider Engagement for State Medicaid Shared Savings Plans
Tuesday, September 10, 2013
by: Policy Team

Section: Public Policy and Advocacy

The Centers for Medicare and Medicaid Services (CMS) released agency guidanceAug. 30 describing the measures states need to consider when designing and implementing Medicare shared savings programs.  CMS notes that states must consider not only cost savings but also quality and health outcomes through care coordination and practice transformation.
Risk-based plans may be approved through state plan amendments as long as: 1) providers are not forced to enter into a risk arrangement as a condition to providing care coordination to Medicaid beneficiaries and 2) providers are aware they are at risk of losing reimbursement if they don’t hit targets. CMS does not specify a preferred model and allows support for efforts that don’t put providers at risk if they fail to reach shared savings targets in the initial stages.  The guidance also notes that states are responsible for making sure providers aren’t at risk for costs they can’t control.  CMS will provide incentives to those programs who do reach shared saving targets with the condition that beneficiary access is not reduced. 
While states are not required to develop specific programs, CMS says the that the Medicare Physician Group Practice Demonstrations, the Pioneer Accountable Care Organization, and the Medicare Shared Savings Program ACOs could provide models.   CMS says making sure benchmark costs and performance period costs are accurate should be one of the main goals for the program.  If calculations and trends are not precise or routinely rebased to match improvements in care coordination and quality, both states and CMS will be at risk.  The guidance is third part of a series that outlines what states need to consider when designing and implementing Medicaid Integrated Care Models and shared savings programs. 
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