Health Reform Medicaid/Medicare

Center for Medicare and Medicaid Innovation

Medicare and Innovation in the same sentence?  Yes indeed.

As part of Health Reform [i.e, Patient Protection and Affordable Care Act (PPACA)], the government mandated the creation of the Center for Medicare and Medicaid Innovation (CMI).

What does CMI do?  “The stated purpose of the CMI is to test innovative payment and service delivery models to bring about a reduction in Medicare and Medicaid program expenditures while preserving or enhancing quality of care.”  Items that CMI might consider are implementing payment mechanisms using accountable care organizations, or pay-for-performance systems using episode grouping technology.  CMI will be especially interested in reforming coverage rules for “dual-eligibles,” beneficiaries who are both eligible for Medicare and Medicaid.  There are 9 million dual eligibles who are, by definition, both elderly and poor.

CMI shall be the research and development arm for CMS.  In addition, CMI will undertake the following roles as well:

  • Lead the design, implementation and evaluation of Medicare and Medicaid demonstrations and pilot programs to test the feasibility, cost effectiveness and quality outcomes of new health care delivery models.
  • Disseminate findings from literature reviews, basic research and program evaluations to inform law makers, academics, and industry about health care delivery issues, new innovative concepts, and demonstrations and pilot programs.
  • Sift through the information and evaluative findings to develop new objectives for basic research and new research demonstrations and provide guidance for the formulation of new program policy proposals and their implementation within the Medicare and Medicaid Programs.

According to Wikipedia, before CMI, “CMS historically has relied on several research and demonstration authorities: §1115(a) of the Social Security Act (which authorizes the HHS Secretary to undertake demonstrations related to Medicaid program design and administration); and other provisions of the Social Security Act which permit demonstrations related to payment, delivery systems, and benefits and coverage.”

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