Colorado Dual Eligible Demonstration

Program Location: 
Denver, CO
Payer Type: 

CMS approved a Memorandum of Understanding (MOU) with the state of Colorado in February 2014. The Colorado Department of Health Care Policy and Financing is partnering with the Centers for Medicare & Medicaid Services to implement a new program designed to better coordinate care for clients who are eligible for both Medicare and Medicaid.   The State Demonstration to Integrate Care for Medicare-Medicaid Enrollees will integrate and coordinate physical, behavioral and social health needs for Medicare-Medicaid clients.

The initiative builds on the infrastructure, resources and provider network found in the Accountable Care Collaborative (ACC) Program, which connects clients with providers, community and social services to help meet client needs. 

Payment Model: 

Medicare and Medicaid Payment and Savings: Providers will receive Fee-for-Service (FFS) payments from CMS for Medicare services. In the Managed Fee-for-Service (MFFS) model currently in place for the ACC Program, Medicaid-covered acute care wraparound services, as well as long-term services and supports (LTSS), are provided in accordance with requirements in the approved Medicaid State Plan and applicable home and community-based service waivers. For the demonstration, the state will pay for Medicaid services based on its prevailing approved Medicaid authorities and payment methodologies. Under this demonstration, the state will be eligible to receive a retrospective performance payment based on quality and savings criteria. For more information on the demonstration's payment model, see Appendix 6 of the approved MOU contract. 

Last updated June 2014
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