Bridging the Aging and Developmental Disabilities Service ... - rrtcadd

the State Demonstrations to Integrate Care for Dual Eligible Individuals CMS awarded contracts
to fifteen states to design service delivery models that integrate health care and long term
services and supports and to improve the coordination of Medicare and Medicaid benefits to
cover their costs. Thirteen states specified they will include dual eligible individuals with
developmental disabilities in their demonstrations. These fifteen states plus 22 other states and
the District of Columbia have submitted letters of intent to test two financial alignment models
CMS proposed to determine their impact on improving beneficiary experiences and quality
outcomes while reducing health and long-term care costs. Both models will include all primary,
acute, behavioral health, and long-term services and supports covered by Medicare and
Medicaid.
1. The Capitated Model provides the managed care organization with a blended rate in
which CMS covers the Medicare portion of the payment and states fund the Medicaid
share. CMS and the state will share any savings resulting from the capitated rate
compared to fee for service costs.
2. The Managed Fee-for-Service Model makes the state responsible for coordinating the
care of dual beneficiaries and delivering fully integrated Medicare and Medicaid benefits.
Under the current system, CMS administers Medicare benefits. Both managed care
options permit states to incorporate coordinated service delivery modes included in the
ACA such as Medicaid Health Homes and primary care case management. States will be
eligible for a retrospective performance payment if the targeted level of Medicare savings
exceeds any Medicaid cost increases and specific quality levels are met. Medicaid and
Medicare providers are reimbursed on a fee-for-service basis by the state and CMS
respectively. 43
Both models must incorporate specific safeguards for consumers including person-centered
assessment and service planning, the right to choose care providers and self-direct services,
voluntary plan enrollment, continuity of care when they transition to the integrated model,
accessible services, and due process for grievances and appeals. Dual eligible beneficiaries will
have meaningful input on implementing these models by serving on advisory boards and plan
governing boards. 44
Lifespan Respite Care Act (P.L. 109-442)
The Lifespan Respite Care Act authorizes funding for state grants to develop coordinated
systems of respite care across the lifespan for all disability groups. It was enacted in 2006 and is
up for reauthorization in 2011. Since 2009, Congress appropriated approximately $2.5 million
annually for the Lifespan Respite Care Act and designated AoA responsible for its
implementation and administration. Over the past three years, 30 states have been awarded
grants to implement respite programs, including four states that are serving large numbers of
individuals with developmental disabilities: Arizona, Texas, Massachusetts, and Wisconsin.
State grantees must involve the ADRCs. The AUCD is on the steering committee for the respite
technical assistance grant AoA awarded to the ARCH National Respite Network. 45
Bridging the Aging and Developmental Disabilities Service Networks Page 28