Medicare-Medicaid Capitated Financial Alignment Model Readiness Reviews

Guidance for all MMPs on comprehensive joint CMS/state readiness review.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: February 11, 2020

As part of the Medicare-Medicaid capitated financial alignment model, the Centers for Medicare & Medicaid Services (CMS) and participating states want to ensure that every selected Medicare-Medicaid plan (MMP) is ready to accept enrollments, provide the necessary continuity of care, ensure access to the spectrum of Medicare, Medicaid, and pharmacy providers, and fully meet the diverse needs of the Medicare-Medicaid population. As such, every selected MMP must pass a comprehensive joint CMS/state readiness review.

The readiness review process will include a specific focus on those areas and processes that directly impact the beneficiary's care including assessment processes, care coordination, provider network development and maintenance, and the MMP's staffing and staff training.

CMS and states work collaboratively to develop state-specific readiness review tools based on stakeholder feedback that states and CMS received through letters and public meetings, the content of the memorandum of understanding between CMS and the state, state-specific procurement documents, applicable Medicare and Medicaid regulations, and input received on previous tools.

Future state-specific readiness review tools will be completed and posted after CMS and the states have signed MOUs.

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