Minnesota’s Demonstration to Integrate Care for Dual Eligibles

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The Minnesota Department of Human Services (DHS) will build on current state initiatives to improve performance of primary care and care coordination models for dual eligibles served in integrated Medicare and Medicaid Special Needs Plans and fee-for-service delivery systems. Dual eligibles refer to people who have benefits through Medicare and Medicaid, known in Minnesota as Medical Assistance.

Existing initiatives include integrated Medicare and Medicaid Special Needs Plan managed care programs such as Minnesota Senior Health Options (MSHO) and Special Needs BasicCare (SNBC), implementation of health care homes including the Medicare Advanced Primary Care Practice demonstration, and provider payment reform through the Health Care Delivery System demonstration. Proposed improvements include development of system-wide performance measures, risk adjustments, provider feedback systems and risk/gain sharing models specific to the dually eligible population.

Minnesota plans to seek waivers or modifications from the federal Centers for Medicare & Medicaid Services (CMS) needed to stabilize Medicare Advantage Special Needs Plans’ participation and to further integrate Medicare into these initiatives. Public meetings will be held periodically to share information on the demonstration and get input from clients, stakeholders and other interested parties.

Public input requested on ICSP Best Practices

DHS’ Health Care and Continuing Care Administrations requested public input on best practices for development of Integrated Care System Partnerships (ICSPs) between managed care organizations and primary, acute, long-term care and mental health providers serving seniors and people with disabilities under managed care programs. The ICSPs are especially for people with dual Medicare and Medicaid eligibility, including those enrolled in MSHO, Minnesota Senior Care Plus (MSC+) and SNBC.

DHS published a Request for Public Input (PDF) and a notice in the State Register on Jan. 22 about the ICSP development process and specific issues on which public comments are requested.

DHS held an ICSP Best Practices Symposium on Jan. 28 to provide information prior to the deadline for written comments, and to gather verbal comments on best practices for development of ICSPs.

Update on status of the Dual Demo

June 29, 2012
DHS staff has been in discussions with CMS and continue to pursue the dual demonstration to improve outcomes for dually eligible populations through new payment reform models as proposed on April 26, 2012. Two possible avenues for the demonstration were discussed, first as one of the original 15 states chosen to move forward with their design models, and another more prescribed financing path called the Financial Alignment Demonstration (FAD).

CMS and DHS have now agreed that it is in Minnesota’s best interests not to pursue the FAD model at this time, though DHS will continue to consider that model in the future as it rolls out in other states. The reason for this decision is that Medicare financing under the FAD model would result in a significantly lower payment than Minnesota is now receiving for senior Medicare beneficiaries in current programs. Lower payments could jeopardize DHS’ proposed purchasing and payment reform strategies.

DHS is making progress in discussions with CMS around the framework for the demonstration’s Memorandum of Understanding (MOU) for 2013 for the senior dual eligible population, and intend to continue discussion with CMS in a second phase for the SNBC group for 2014 as stated in the proposal. Please note that the purchasing models (Model 1 and Model 2 with a future Model 3 for SNBC members) continue to be the core of this dual eligible demonstration as originally proposed.

Demonstration proposal submitted to CMS

On April 26, 2012, DHS submitted its final proposal for Re-designing Integrated Medicare and Medicaid Financing and Delivery for People with Dual Eligibility in Minnesota. The proposal and related documents are below. CMS held a 30-day public comment period for the submitted proposal that ended May 31.

Governor Mark Dayton’s letter (PDF)
DHS cover letter (PDF)
Proposal (PDF)
Appendix 1: Related purchasing models (PDF)
Appendix 2: Summary integrated appeals protocol (PDF)
Appendix 3: Payment and operational waivers, requests and recommendations (PDF)
Appendix 4: Stakeholder input summary (PDF)
Appendix 5: Current Performance Improvement Projects summary (PDF)
Appendix 6: Comments and letters of support for this proposal (PDF)

Draft proposal and public comment period
DHS’ draft proposal for Re-designing Integrated Medicare and Medicaid Financing and Delivery for People with Dual Eligibility in Minnesota (PDF) was available on this page for a 30-day public comment period that ended April 19. Comments received (see Appendix 6 above) were reviewed and informed the final proposal sent to CMS.

Previous documents sent to CMS

Interim progress report sent to CMS, October 2011 (PDF)
DHS contract with CMS, April 2011 (PDF)
DHS proposal in response to CMS’ request for proposals, January 2011 (PDF)

Related information

Minnesota DHS contacts

For more information, contact:
Pamela Parker, Manager of Minnesota’s Special Needs Purchasing
Dr. Jeff Schiff, Medical Director for Minnesota Health Care Programs
Deb Maruska, Minnesota’s dual demo project coordinator