South Carolina Capitated Financial Alignment Model Demonstration (Healthy Connections Prime)
Guidance for South Carolina Capitated Financial Alignment Model Demonstration (Healthy Connections Prime).
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 31, 2020
South Carolina Capitated Financial Alignment Model Demonstration (Healthy Connections Prime)
SPOTLIGHT & RELEASES
| 04/23/2024: CMS released the South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 7. More information is available below. |
On October 25, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that the state of South Carolina will partner with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.
Under the demonstration, called Healthy Connections Prime, South Carolina and CMS will contract with Medicare-Medicaid plans to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees.
Key Dates
October 25, 2013 - CMS and South Carolina sign MOU
September 15, 2014 - CMS, South Carolina, and participating plans execute three-way contract
February 1, 2015 - Start of opt-in enrollment
April 1, 2016 - Start of passive enrollment
November 1, 2017 - CMS, South Carolina, and participating plans execute three-way contract amendment
July 1, 2018 - CMS, South Carolina, and participating plans execute three-way contract amendment
July 1, 2020 - CMS, South Carolina, and participating plans execute three-way contract amendment
January 1, 2022 - CMS, South Carolina, and participating plans execute updated three-way contract
August 1, 2023 - CMS, South Carolina, and participating plans execute updated three-way contract
More information from CMS:
- Fact Sheet
- Three-Way Contract (PDF)
- Three-Way Contract (08/01/2023) (DOCX)
- MOU (PDF)
- State Proposal (PDF)
- Third Evaluation Report for the South Carolina capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (12/20/2023)
- Second Evaluation Report for the South Carolina capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (01/11/2022)
- First Evaluation Report for the South Carolina capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (09/24/2019)
- Readiness Review Tool (PDF)
- South Carolina Evaluation Design Plan (PDF)
- Letter of Intent to Extend Scheduled End Date (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6 (PDF)
- South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 7 (PDF)
Information for Plans:
- All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.
Information for Beneficiaries and Providers:
- South Carolina Healthy Connections Prime Continuity of Care Provisions (PDF)
- Healthy Connections Prime Ombudsman Program
- South Carolina Healthy Connections Prime Provider Frequently Asked Questions (FAQs) (PDF)
Information from the state of South Carolina:
Funding Support:
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