South Carolina Healthy Connections Prime

Program Location: 
Columbia, SC
Payer Type: 

South Carolina signed a Memorandum of Understanding with CMS on October, 25 2013, approving its new pilot program to provide integrated and coordinated care for individuals who are eligible for both Medicare and Medicaid. Healthy Connections Prime realigns incentives so Medicare and Medicaid services can work in a single system, resulting in a simpler health care experience that improves quality, reduces costs and enhances patient satisfaction. It will transform the state’s health care system to deliver patient-centered care that integrates all types of care services, including medical, behavioral health and long-term services and supports. South Carolina received federal funding to design a service delivery model that integrates care to meet the often complex and costly medical needs of individuals who receive services from both Medicare and Medicaid.

Eligible beneficiaries who enroll in the pilot program will be able to receive both Medicare and Medicaid services, plus additional behavioral health and community support services through one health plan that promotes clinically integrated, patient-centered care and improves health outcomes, delays the need for nursing facility care, reduces avoidable emergency room visits and hospital readmissions and increases access to home and community-based services.

Healthy Connections Prime Program Update July 2018 - Healthy Connections Prime Extended

Payment Model: 

Medicare and Medicaid will each contribute to the total capitation payment consistent with projected baseline spending contributions.  Demonstration savings percentages assume that CICOs are responsible for the full range of services covered under the Demonstration. Aggregate savings percentages will be applied equally to the Medicaid and Medicare Parts A and B components. Both CMS and the State will contribute to the methodologies used to develop their respective components of the overall blended rate. For more information on the demonstration's payment model, review Appendix 6 of the approved CMS MOU.  

Last updated April 2019
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