Minnesota Senior Health Options program (MSHO)
Program Location:
Minneapolis, MN
Payer Type:
Medicare
Parent Program:
Payers:
Medicare
Reported Outcomes
Description:
DHS and the Centers for Medicare and Medicaid Services (CMS) signed a Memorandum of Understanding (MOU) establishing a “Demonstration to Align Administrative Functions for Improvements in Medicare-Medicaid Beneficiary Experience” within the Minnesota Senior Health Options Program (MSHO). The demonstration is also referred to as the “Dual Demo.”
The Dual Demo began on September 13, 2013, continues until December 31, 2016, and is designed to:
• Enhance integration of services for Medicare-Medicaid Beneficiaries through payment reform and new provider payment models with beneficiaries who are dually eligible for both Medicare and Medicaid.
• Clarify and simplify information and processes for Beneficiaries and their families related to Medicare and Medicaid coverage.
• Better align oversight of MSHO Plans by the State and CMS.
• Improve administrative efficiencies for the MSHO Plans and government agencies that serve MSHO Enrollees.
• Avoid unnecessary duplication through a joint federal-state monitoring and quality oversight process and a coordinated set of reporting requirements.
Payment Model:
Minnesota created Health Care Homes (HCHs) to provide payments to primary care providers that would incent better coordination of the entire spectrum of care provided to an individual. Building on the current all-payer HCH requirements in Minnesota, under the Demonstration the State and MSHO Plans will identify options for increasing coordination among MSHO Plans and the plan care coordinators, contracted clinics, and practitioners certified as health care homes, as well as with other contracted providers
Improved Access:
- Its enrollment was 35,272 in June 2015, or 72 percent of the full-benefit Medicare-Medicaid enrollees aged 65 or older enrolled in Medicaid managed care
Other Outcomes:
- Minnesota utilization patterns generally appear similar before and after the demonstration, with lower institutional use and higher utilization of community-based providers when comparing Minnesota Senior Health Options, the fully integrated program vs. Minnesota Senior Care Plus, a managed Medicaid plan that may coordinate services with Medicare FFS.
