On December 15, 2016, HHS announced an Accountable Care Organization (ACO) initiative for beneficiaries who are dually eligible for Medicare and Medicaid. The Medicare-Medicaid ACO Model (Model) builds on the Medicare Shared Savings Program. Currently, Medicare ACO initiatives do not have financial accountability for the cost of Medicaid expenditures or for quality of care of Medicare-Medicaid dual enrollees.
Through this initiative, CMS will partner with up to six interested states to offer Medicare ACOs in those states the opportunity to manage Medicaid costs for Medicare-Medicaid dual enrollees. Interested states must have a sufficient number of Medicare-Medicaid dual enrollees in fee-for-service Medicare and Medicaid, but preference will be given to states with low Medicare ACO saturation. States can submit a letter of intent to participate in the Model and choose from three options for when to begin the first 12-month performance period: January 1, 2018; January 1, 2019; or January 1, 2020. Once a state is approved to participate in the Model, a request for application will be released to ACOs and providers in that state.
Additional information on the Medicare-Medicaid ACO Model, including how to apply, is available here.