Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals: Massachusetts Evaluation Design Plan.

CMS contracted with RTI International to monitor the implementation of all State demonstrations under the Financial Alignment Initiative, and to evaluate their impact on beneficiary experience, quality, utilization, and cost. The evaluation includes an aggregate evaluation and State-specific evaluations. This report describes the State-specific Evaluation Plan for the Massachusetts demonstration as of December 16, 2013. The evaluation activities may be revised if modifications are made to either the Massachusetts demonstration or to the activities described in the Aggregate Evaluation Plan (Walsh et al., 2013). Although this document will not be revised to address all changes that may occur, the annual and final evaluation reports will note areas where the evaluation as executed differs from this evaluation plan. The goals of the evaluation are to monitor demonstration implementation, evaluate the impact of the demonstration on the beneficiary experience, monitor unintended consequences, and monitor and evaluate the demonstration’s impact on a range of outcomes for the eligible population as a whole and for subpopulations (e.g., people with mental illness and/or substance use disorders and long-term services and supports (LTSS) recipients)

Financial Alignment Initiative: New York Integrated Appeals and Grievances Demonstration. First Brief Report

Beneficiaries who are dually eligible for Medicare-Medicaid and who are enrolled in managed care plans must navigate two different systems if they appeal their plan’s reduction, termination, or denial of service. Medicare and Medicaid have different policies and procedures and navigating these two systems is administratively complex and challenging for beneficiaries. The Centers for Medicare & Medicaid Services (CMS)-New York Integrated Appeals and Grievances demonstration is designed to integrate and streamline these processes. CMS contracted with RTI International to conduct an independent evaluation of the New York Integrated Appeals and Grievances demonstration to determine its impact on beneficiary and plan experience. This first brief report covers the first demonstration year, January 1, 2020 through December 31, 2020. It includes findings from interviews conducted in spring 2021 with beneficiary advocates, plans, CMS, and New York State officials. We also include an analysis of Medicare cost savings generated by the NY Integrated A&G demonstration that was conducted by the CMS Medicare/Medicaid Coordination Office (MMCO)

Financial Alignment Initiative New York FIDA Combined Second and Third Evaluation Report

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Medicare-Medicaid Financial Alignment Initiative (FAI) to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. New York and CMS launched the Fully Integrated Duals Advantage (FIDA) demonstration on January 1, 2015, to integrate care for Medicare-Medicaid beneficiaries in the greater New York City area. The demonstration ended on December 31, 2019. Initially, twent-yone Medicare-Medicaid Plans (MMPs) participated in the demonstration. In the final year, six MMPs remained. MMPs received capitated payments from CMS and the State to finance all Medicare and Medicaid services. Stakeholders supported the demonstration’s elements of streamlined care planning and service authorization processes, and its integrated appeals process allowing a single path to appeal both Medicare and Medicaid service decisions. However, due to a combination of design choices, environmental factors, and early implementation missteps, a large number of potential enrollees and providers opted out of participation. Although New York and CMS addressed many of the issues, FIDA was plagued by its early negative reputation and declining enrollment throughout the life of the demonstration. Out of over 100,000 eligible beneficiaries, enrollment peaked in October 2015 at 8,833 and declined to 2,320 as of December 2019. In this evaluation report for the New York FIDA demonstration, we describe demonstration implementation activity from 2017 through 2019, and the considerable planning activity during the final demonstration years to create an option to seamlessly transition FIDA enrollees into existing MAP plans aligned with Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) under the same MMP parent organization.3 We include findings from qualitative data for 2017–2019. Using qualitative data gathered throughout the demonstration (2015–2019), we also present overall demonstration successes, challenges, and lessons learned at the end of the report