Assistance program
One-Time Funding in Support of the Vermont All-Payer ACO Model
-$451 committed in FY2018–FY2018
- Agency
- Centers for Medicare and Medicaid Services, Health and Human Services, Department of
- Assistance
- Cooperative Agreements
- CFDA number
- 93.961
- What it does
- The purpose of this single source funding opportunity for the One-Time Funding in Support of Vermont’s All-Payer ACO Model (“Modelâ€) cooperative agreement is to provide Vermont with the start-up costs of the Model to assist Vermont in accomplishing the health outcomes, financial, and ACO scale targets required of Vermont under the Model. A single-source award to the Agency for Human Services will enable CMS to expeditiously provide assistance to Vermont for the following specific activities: connect Medicare Fee-for-Service beneficiaries with community-based resources, coordinate transitions across care settings with appropriate involvement of the Medicare Fee-for-Service beneficiary’s primary care provider, coordinate care across providers, support health promotion and self-management by Medicare Fee-for-Service beneficiaries, and support practice improvement and transformation. These activities are necessary for Vermont to achieve the goals of the Model. We note that the other components of the Model (e.g., Vermont-specific Medicare ACO initiative and statewide health outcomes, financial, and ACO scale targets) are governed by a separate State Agreement into which Vermont and CMS have entered.
- Who benefits
- CMS is committed to achieving better care for individuals, better health for populations, and reduced expenditures for Medicare, Medicaid, and CHIP. Through the Innovation Center, CMS strives towards these goals by testing innovative payment and service delivery models. CMS believes that states can be critical partners of the federal government and other health care payers to facilitate the design, implementation, and evaluation of community-centered health systems that can deliver significantly improved cost, quality, and population health performance results for all state residents, including Medicare, Medicaid, and CHIP beneficiaries. States have policy and regulatory authorities, as well as ongoing relationships with commercial healthcare payers, health plans, and providers that can accelerate delivery system reform. CMS has previously partnered with states to accelerate delivery system reform through initiatives such as the State Innovations Model (SIM). SIM provides state-based healthcare transformation efforts with funding to test the ability of states to utilize policy and regulatory levers to accelerate multi-payer health care transformation. Selected states have been working with state-based payers, including Medicaid and commercial payers, and providers to design and implement care delivery and payment reform. States participating in SIM were selected through two rounds of public Funding Opportunity Announcements released on August 23, 2012 (Round 1) and May 22, 2014 (Round 2). Additionally, CMS has released guidance to SIM state participants in which CMS indicated that in certain instances it will consider state proposals for Medicare’s alignment with state multi-payer payment and care delivery models. According to that guidance, CMS indicated that CMS would assess such proposals with consideration of the following principles: 1) patient-centered, 2) accountable for total cost of care, 3)transformativee, 4) broad-based, 5) feasible to implement, and 6) feasible to evaluate. Vermont was one state that approached CMS with a desire for Medicare’s alignment with the state’s payment and care delivery model, and Vermont publicly released its proposal on January 25, 2016 . CMS reviewed Vermont’s proposal and determined that it met the requirements necessary to explore in detail a potential Vermont-specific model. In October 2016, CMS and the State of Vermont entered into a State Agreement on the Vermont All-payer ACO Model. Under the Model, CMS will test whether health and care delivery for Vermont residents improve and healthcare expenditures for beneficiaries across payers (including Medicare fee-for-service, Vermont Medicaid, Vermont Commercial Plans, and Vermont Self-insured Plans) decrease if a) the aforementioned payers offer Vermont ACOs risk-based arrangements tied to health outcomes and healthcare expenditures; b) the majority of Vermont providers and/or suppliers enter into such risk-based arrangements; and c) the majority of Vermont residents across payers are aligned to an ACO bound by such arrangements. Start-up funding through a Cooperative Agreement will assist Vermont in achieving the above goals of the Model. As part of the Model, Vermont providers will participate in a Vermont-specific Medicare ACO initiative (the “Vermont Medicare ACO Initiativeâ€), and CMS will provide $9.5M in start-up costs to assist Vermont providers with care coordination and bolster their collaboration with community-based resources. In return, Vermont commits to achieving statewide health outcomes, financial, and ACO scale (percentage of Vermont residents aligned to an ACO) targets – both for Medicare and across all significant healthcare payers. CMS believes that care coordination and collaboration with community-based resources will be necessary in order to achieve the financial, health outcomes, and ACO scale targets required under the Model. The start-up costs of the Model that CMS is providing to Vermont through a Cooperative Agreement will support such care coordination and collaboration with community-based resources, and will better enable Vermont to achieve the Model’s financial, health outcomes, and ACO scale targets.
- Who applies
- This single source funding opportunity provides Vermont with the necessary start-costs of the Model and is open to Vermont’s Agency for Human Services (“Agencyâ€). The Agency is uniquely positioned to meet the objectives of this funding opportunity based on its existing knowledge of the Model, its regulatory authority over healthcare in Vermont and its role in administering the Vermont All-payer ACO Model, its existing partnerships and collaborations with Vermont providers, and its resources and ability to deploy the funding immediately. • Knowledge of the Model: the Agency is intimately familiar with the objectives of the Model. The Agency was a key member of the discussions between Vermont and CMS during the development of the Model; the Agency’s Secretary and staff dedicated significant time, energy, and resources over the past year in partnering with CMS to establish the Model’s financial, health outcomes, and ACO scale targets. This existing familiarity and knowledge of the Model will help the Agency to expediently deploy the upfront investment in the Model offered under this funding opportunity announcement. • Authority and role in administering the Model: The Agency is responsible for ensuring that changes in Vermont’s health system improve the conditions and well-being of Vermonters. The Agency has broad Vermont healthcare authority to improve the health of Vermonters and control the rate of growth in healthcare costs. Additionally, the Agency is a signatory to the Vermont All-payer ACO Model’s State Agreement and will be supporting the State in achieving its obligations under the State Agreement. The Agency can effectively complement this funding opportunity with its existing authority and role in administering the Model to ensure the funding is effectively used in achieving the Model’s goals. • Existing partnership and collaboration: The Agency is located in Vermont and has existing relationships and a history of collaboration with Vermont providers and community-based resources that would benefit from this funding opportunity. The Agency has also been working with these stakeholders for their input through the development of the Model. • Resources and ability to implement immediately: The Agency has the staff to implement this award immediately to support providers engaging in care coordination and linking beneficiaries to community-based resources.
- Authorized by
- Social Security Act, section 1115A
- Program site
- http://www.innovation.cms.gov ↗
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