In July, the Ocean State became the thirteenth state to sign a Memorandum of Understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to move forward with integrating services and financing for its Medicare-Medicaid population (dual eligible). While many challenges have surfaced with the twelve demonstrations already underway, we see some improvements in this MOU. For instance, the Rhode Island MOU:
- includes the strongest provisions of any MOU to promote rebalancing from nursing homes to community care
- is the only MOU that, from the start, offers protections in the form of risk corridors for all three years
- contains strong policies on assisting enrollees with transitions between care settings.
Still, as with the other ongoing demonstration projects, “the devil is in the details.” And there are still a lot of details to get right for Rhode Island, as outlined in this fact sheet. Rhode Island advocates are hard at work nailing down these details, including ensuring that enrollment goes smoothly and that older adult enrollees receive geriatric-competent care, as our state partners emphasized in a recent Op-Ed in the Providence Journal. These details will be part of a three-way contract which is currently under negotiation between CMS, the State and the participating health plan (Neighborhood Health Plan of Rhode Island). Most of all, their work ensures that consumers and their advocates are at the table as these decisions are being made.
As we’ve learned over the past two years, getting these demonstrations right takes time, vigilance and course corrections. The RI MOU signifies a cautious step in the right direction. But the hard work starts now. The readiness review process and details of the three-way contract will be important to watch. As with any new health system transformation initiative, ongoing transparent collaboration with consumers and their advocates will be vital to getting it right.