Model Overview Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services (CMS) 1
Agenda • CMS Innovation Center • Background and Opportunity • MOM Model Goals and Design • Timeline and Next Steps 2
CMS Innovation Center 3
The CMS Innovation Center Statute “The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care furnished to individuals under such titles.” zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Three scenarios for success from statute: 1. Quality improves; cost neutral 2. Quality neutral; cost reduced 3. Quality improves; cost reduced (best case) If a model meets one of these three criteria and other statutory prerequisites, the statute allows the Secretary to expand the duration and scope of a model through rulemaking. 4
Maternal Opioid Misuse in Medicaid 5
Impacts of Maternal Substance Use • Maternal mortality • Preterm birth • Poor obstetric outcomes • Low birth weight • Malnourishment • A collection of withdrawal • Interpersonal violence symptoms called neonatal • Other health-related social needs abstinence syndrome (NAS) 6
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Costs to Medicaid Medicaid pays the largest portion of hospital charges for maternal substance use, as well as a majority of the $1.5 billion annual cost of NAS. 7
Key Barriers to Quality Care Provider Capacity Limited Access Fragmented Care Available providers Many women with Even with covered are lacking to treat OUD lack access to services, providers pregnant and and systems caring comprehensive postpartum women services during for this population with OUD covered pregnancy and the rarely integrate or by Medicaid postpartum period coordinate effectively 8
MOM Model 9
Model Goals 01 02 03 Create sustainable Improve quality of care Expand access to coverage and and reduce costs for treatment, service- payment strategies pregnant and delivery capacity, and that support ongoing postpartum women with infrastructure based on coordination and OUD and their infants state-specific needs integration of care 10
Model Interventions 01 02 03 Support the delivery Leverage the use of Invest in institutional of coordinated and existing Medicaid and organizational integrated physical flexibility to support capacity to address key health care, sustainable care for challenges in the behavioral health the model population provision of coordinated care, and critical and integrated care wraparound services 11
Awardee and Awardee Partner(s) The Innovation Center will issue awards directly to state Medicaid agencies, which will implement the model with one or more “care-delivery partners.” 12
Coordinated and Integrated Care Behavioral Health Physical Health Mental health services, Medication assisted group therapy, and other treatment (MAT) for OUD, appropriate therapies maternity care, and beyond MAT relevant primary care services 13
Wraparound Services zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Coordination, engagement, and referral services to support initiation and maintenance of evidence-based treatment by removing potential health or health-related social barriers to accessing care. 14
Care-Delivery Structure and Funding 15
Five-Year Model with Three Distinct Periods zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Pre- Full Implementation Transition Implementation (Year 2) (Years 3-5) (Year 1) Grant Funding Opportunities Year 1 Year 2 Years 3-5 • Implementation • Implementation • Implementation • Transition • Milestone 16
Next Steps 17
Timeline Early 2019 Release Notice of Funding Opportunity (NOFO) Fall 2019 Award cooperative agreements 18
How to Prepare Identify state and local priorities Seek opportunities for partnership Stay tuned for NOFO release 19
Resources and Contact Info Email: MOMmodel@cms.hhs.gov Visit link: MOM Model Website 20
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