In July 2015, CMS signed a Memorandum of Understanding with the state of Rhode Island to pilot the Medicare-Medicaid Alignment Integrated Care Initiative Demonstration. The goal of Rhode Island’s Integrated Care Initiative (ICI) is to improve the care and quality of life for elders and adults with disabilities who are eligible for both Medicare and Medicaid. Rhode Island’s ICI is being implemented in two phases. Phase 1 started in November 2013 with the enrollment of eligible individuals into managed care for their Medicaid benefits including long-term services and supports (LTSS). Under Phase I of the Integrated Care Initiative, the State introduced an enhanced Primary Care Case Management model called Connect Care Choice Community Partners (CCCCP) and a Medicaid health plan model called the Rhody Health Options (RHO) program, available to Medicaid-only and Medicare-Medicaid Beneficiaries under the Rhode Island Comprehensive Section 1115(a) demonstration. CCCCP is designed to achieve and preserve access to primary, preventive, behavioral health, and specialty care that allows the individual to remain well and independent in the community and decrease unnecessary acute episodes of care
The Integrated Care Initiative - Phase 2 will offer a fully integrated model that combines all the Medicare and Medicaid benefits through a health plan. Phase 2 is designed to coordinate both Medicare and Medicaid benefits into one, integrated delivery system for eligible members. The ICI Phase 2 is a partnership between the Centers for Medicare and Medicaid Services (CMS) and the State of Rhode Island. CMS issued a press release on July 30, 2015 announcing the Memorandum of Understanding between the State and CMS.
Neighborhood Health Plan of Rhode Island will be contracting with the State to administer Phase 2 of the Integrated Care Initiative for eligible members (people with both Medicare and Medicaid). The new program will be called Neighborhood INTEGRITY. Members will be offered enrollment in the new program in the winter of 2015/2016.
Rates and Financial Terms: For each calendar year of the Demonstration, before rates are offered to MMPs, CMS shall share with the State the amount of the Medicare portion of the capitated rate, as well as collaborate to establish the data and documentation needed to assure that the Medicaid portion of the capitation rate is consistent with all applicable Federal
requirements.
Blended Medicare and Medicaid Payment: CMS will make separate payments to the MMPs for the Medicare A/B and Part D components of the rate. The State will make a payment to the MMPs for the Medicaid component of the rate, as more fully detailed in Appendix 6.
