Feasibility of Managed Care/Accountable Care Contracting in the MaineCare Program Presented to the Joint Standing Committee on Health and Human Services by the Department of Health and Human Services 3/10/10
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Fea
sib
ility
of
Ma
na
ge
d
Ca
re/A
cco
un
tab
le C
are
Co
ntr
act
ing
C
are
/Acc
ou
nta
ble
Ca
re C
on
tra
ctin
g
in t
he
Ma
ine
Ca
reP
rog
ram
Pre
sen
ted
to
th
e J
oin
t St
an
din
g C
om
mit
tee
o
n H
ea
lth
an
d H
um
an
Se
rvic
es
by
the
D
ep
art
me
nt
of
He
alt
h a
nd
Hu
ma
n S
erv
ice
s
3/1
0/1
0
Leg
isla
tive
Ch
arg
e
Th
e D
ep
art
me
nt…
.sh
all
inve
stig
ate
th
e f
ea
sib
ility
of
ob
tain
ing
a w
aiv
er
fro
m t
he
fe
de
ral C
MS
to
est
ab
lish
a r
isk-
ba
sed
ma
na
ge
d c
are
co
ntr
act
fo
r sp
eci
fic
Ma
ine
Ca
rep
op
ula
tio
ns
or
serv
ice
s. T
he
d
ep
art
me
nt
sha
ll su
bm
it it
s fi
nd
ing
s a
nd
d
ep
art
me
nt
sha
ll su
bm
it it
s fi
nd
ing
s a
nd
re
com
me
nd
ati
on
sa
lon
g w
ith
th
e p
roje
cte
d n
et
cost
sa
vin
gs
an
d t
he
pro
ject
ed
imp
act
on
qu
alit
y o
f ca
re a
nd
he
alt
h o
utc
om
es
to t
he
Jo
int
Sta
nd
ing
C
om
mit
tee
on
He
alt
h H
um
an
Se
rvic
es
no
late
r th
an
Ap
ril 1
, 2
01
0.
4/2
7/2
01
02
Typ
es
of
Ma
na
ge
d C
are
•P
rim
ary
Ca
re C
ase
Ma
na
gem
en
t (P
CC
M):
P
rim
ary
ca
re p
ract
itio
ne
r re
ceiv
es
a
mo
nth
ly c
ase
ma
na
ge
me
nt
fee
pe
r p
ati
en
t to
co
ord
ina
te c
are
an
d m
ake
re
ferr
als
to s
pe
cia
lty
care
. S
erv
ice
s re
imb
urs
ed
on
a f
ee
-fo
r-se
rvic
e.
•P
ati
en
t-C
en
tere
d M
ed
ica
l Ho
me
(P
CM
H):
Si
mila
r to
PC
CM
, b
ut
wit
h g
rea
ter
exp
ect
ati
on
s o
f th
e p
ract
ice
. “
A m
od
el o
f ca
re p
rovi
de
d b
y p
hys
icia
n p
ract
ice
s th
at
see
ks t
o s
tre
ngt
he
n t
he
ph
ysic
ian
-pa
tie
nt
rela
tio
nsh
ip b
y re
pla
cin
g e
pis
od
ic
care
…w
ith
co
ord
ina
ted
ca
re..”
(NC
QA
)
•P
art
ial
Ris
k C
on
tra
ctin
g:
Co
ntr
act
or
ag
ree
s to
pro
vid
e s
om
e,
bu
t n
ot
all
serv
ice
s
for
a s
et
am
ou
nt
pe
r p
ers
on
pe
r m
on
th (
PM
PM
).
Som
e s
erv
ice
s co
nti
nu
e t
o b
e
for
a s
et
am
ou
nt
pe
r p
ers
on
pe
r m
on
th (
PM
PM
).
Som
e s
erv
ice
s co
nti
nu
e t
o b
e
reim
bu
rse
d o
n a
fe
e-f
or-
serv
ice
ba
sis.
Or
pro
vid
er
limit
s ri
sk t
o a
co
rrid
or
aro
un
d a
targ
ete
d a
mo
un
t. A
n e
xam
ple
of
a c
orr
ido
r is
a c
ost
sh
ari
ng
/ga
in a
rou
nd
+/-
10
%
of
a t
arg
et
am
ou
nt.
•Fu
ll R
isk
Co
ntr
act
ing
: C
on
tra
cto
r a
gre
es
to p
rovi
de
all
serv
ice
s fo
r a
se
t a
mo
un
t o
n
a p
er
pe
rso
n p
er
mo
nth
(P
MP
M)
ba
sis
(fu
ll ca
pit
ati
on
).
Th
e c
on
tra
cto
r is
at
risk
fo
r
cost
s th
at
exc
ee
d t
he
ca
pit
ati
on
.
•A
cco
un
tab
le C
are
Org
an
iza
tio
n:
A p
rovi
de
r o
rga
niz
ati
on
wh
ich
ass
um
es
acc
ou
nta
bili
ty f
or
a g
lob
al b
ud
ge
t a
nd
he
alt
h o
utc
om
es.
•M
an
age
d C
are
Org
an
iza
tio
n:
A m
an
ag
ed
ca
re o
rga
niz
ati
on
wh
ich
ass
um
es
resp
on
sib
ility
fo
r a
glo
ba
l bu
dg
et,
ou
tco
me
s, in
sura
nce
ris
k a
nd
cla
ims
pro
cess
ing
. 4
/27
/20
10
3
Wh
y St
ate
s A
do
pt
Ris
k-b
ase
d C
on
tra
cts
an
d O
the
r A
cco
un
tab
le C
are
Ap
pro
ach
es
•Im
pro
ve a
cco
un
tab
ility
an
d m
ea
sure
me
nt
of
qu
alit
y o
f ca
re,
he
alt
h s
tatu
s a
nd
ou
tco
me
s
•R
ed
uce
pe
r m
em
be
r co
st
•M
ake
exp
en
dit
ure
s m
ore
pre
dic
tab
le
•A
lign
ince
nti
ves
of
pa
yers
, p
rovi
de
rs,
me
mb
ers
4/2
7/2
01
04
Ma
na
ge
d C
are
Org
an
iza
tio
n M
od
el
DH
HS/
Ma
ine
Ca
re
Ris
k B
ea
rin
g C
on
tra
cto
r:
Ma
na
ge
d C
are
Org
an
iza
tio
n
Ma
na
ge
d C
are
Org
an
iza
tio
n
(MC
O)
resp
on
sib
le f
or
me
mb
er
serv
ice
s, q
ua
lity
, pro
vid
er
ne
two
rk,
an
d in
suri
ng
ris
k.
Fe
e f
or
Se
rvic
e
Pro
vid
ers
Ca
pita
ted
Pro
vid
ers
4/2
7/2
01
05
Acc
ou
nta
ble
Ca
re O
rga
niz
ati
on
Mo
de
lD
HH
S/
Ma
ine
Ca
re
Ris
k B
ea
rin
g C
on
tra
cto
r:
He
alt
hca
re S
yste
m a
s a
n
AC
O,
resp
on
sib
le f
or
Insu
ran
ce a
nd
Ad
min
istr
ati
ve
AC
O,
resp
on
sib
le f
or
me
mb
er
serv
ice
s, q
ua
lity
,
pro
vid
er
ne
two
rk w
ith
in a
glo
ba
l bu
dg
et.
Insu
ran
ce a
nd
Ad
min
istr
ati
ve
Serv
ice
s (p
art
ne
rsh
ip w
ith
pa
yer)
Co
ntr
act
ing
wit
h o
the
r se
rvic
e
pro
vid
ers
fo
r re
qu
ire
d s
erv
ice
s
wh
en
no
t a
vail
ab
le t
hro
ug
h t
he
acc
ou
nta
ble
he
alt
hca
re
org
an
iza
tio
n
4/2
7/2
01
06
Na
tio
na
l Me
dic
aid
En
rollm
en
t in
Ma
na
ge
d C
are
•7
1%
of
Me
dic
aid
me
mb
ers
na
tio
na
lly a
re
un
de
r ri
sk-b
ase
d m
an
ag
ed
ca
re o
r P
rim
ary
Ca
re C
ase
Ma
na
ge
me
nt.
•8
0%
of
the
ma
na
ge
d c
are
me
mb
ers
are
in f
ull
•8
0%
of
the
ma
na
ge
d c
are
me
mb
ers
are
in f
ull
or
pa
rtia
l ris
k-b
ase
d a
rra
ng
em
en
ts.
4/2
7/2
01
07
Cu
rre
nt
Ma
ine
Ca
re M
em
be
rsh
ip
Medicaid Category
PrimaryCare Case
Management
(PCCM)*
Total
MaineCare
Members
Child
ren’s
Health Insura
nce P
rogra
m (
CH
IP)
Child
ren’s
Health Insura
nce P
rogra
m (
CH
IP)
and F
oste
r C
are
18,6
02
23,3
91
Tem
pora
ry A
id to N
eedy F
am
ilies (T
AN
F)
147,2
32
174,9
03
Child
less A
dults (
Non-C
at W
aiv
er)
9,2
77
10,6
88
Supple
menta
l S
ecurity
Incom
e (
SS
I)14,8
75
37,8
66
Oth
er
39,1
55
Total
189,986
286,003
* O
f th
e 1
89,9
86 P
CC
M m
em
bers
, 21,1
03 a
re a
lso in P
atient C
ente
red M
edic
al H
om
e (
PC
MH
)4
/27
/20
10
8
4/2
7/2
01
09
Ma
na
ge
d C
are
Su
cce
ss
Less
on
s le
arn
ed
na
tio
na
lly
•C
ult
iva
te l
on
g t
erm
co
lla
bo
rati
ve
re
lati
on
ship
s w
ith
con
tra
cto
rs;
•M
ea
sure
pe
rfo
rma
nce
, w
hic
h r
eq
uir
es
ea
rly
att
en
tio
n t
o d
ata
ga
the
rin
g a
nd
an
aly
sis;
att
en
tio
n t
o d
ata
ga
the
rin
g a
nd
an
aly
sis;
•E
nga
ge
sta
keh
old
ers
ea
rly
an
d c
on
tin
uo
usl
y;
•B
uil
d e
ffe
ctiv
e a
dm
inis
tra
tiv
e i
nfr
ast
ruct
ure
; a
nd
•A
da
pt
to l
oca
l co
nd
itio
ns.
4/2
7/2
01
01
0
Fea
sib
ility
Fa
cto
rs
•C
on
tra
cto
r ca
pa
city
an
d in
tere
st
•St
ake
ho
lde
r e
nga
ge
me
nt
(me
mb
ers
,
pro
vid
ers
, a
dvo
cate
s, D
HH
S p
rog
ram
s)
•St
ate
ad
min
istr
ati
ve r
eso
urc
es
an
d c
ap
aci
ty•
Sta
te a
dm
inis
tra
tive
re
sou
rce
s a
nd
ca
pa
city
•Fe
de
ral a
uth
ori
ty
4/2
7/2
01
01
1
Co
ntr
act
or
Ca
pa
city
an
d I
nte
rest
•R
eq
ue
st f
or
Info
rma
tio
n (
RFI
) is
sue
d 1
2/2
1/0
9
to 9
2 in
sure
rs,
pro
vid
ers
an
d o
the
r in
tere
ste
d
pa
rtie
s
•2
2 r
esp
on
ses
by
2/1
/10
–9
na
tio
na
l org
an
iza
tio
ns,
6 o
f w
hic
h a
re w
illin
g t
o
–9
na
tio
na
l org
an
iza
tio
ns,
6 o
f w
hic
h a
re w
illin
g t
o
be
ar
full
risk
(4
on
a s
tate
wid
e b
asi
s)
–2
ho
spit
al-
ba
sed
sys
tem
s, 1
sta
tew
ide
an
d 1
cove
rin
g 6
we
ste
rn c
ou
nti
es
–5
ind
ivid
ua
l h
osp
ita
ls
–5
pri
ma
ry c
are
or
spe
cia
lty
pro
vid
er
org
an
iza
tio
ns
–1
org
an
iza
tio
n o
ffe
rin
g c
on
sult
ing
se
rvic
es
4/2
7/2
01
01
2
Fin
din
gs:
Co
ntr
act
or
Ca
pa
city
an
d
Inte
rest
Th
e D
ep
art
me
nt
fin
ds
suff
icie
nt
inte
rest
an
d c
ap
aci
ty
am
on
g p
ote
nti
al co
ntr
act
ors
to
pro
cee
d w
ith
mo
re
spe
cifi
c p
rog
ram
de
ve
lop
me
nt.
Th
e b
roa
d r
an
ge
of
org
an
iza
tio
ns
resp
on
din
g,
an
d t
he
va
rie
ty o
f ri
sk
arr
an
ge
me
nts
pro
po
sed
un
de
rsco
res
tha
t a
ris
k-
arr
an
ge
me
nts
pro
po
sed
un
de
rsco
res
tha
t a
ris
k-
ba
sed
Ma
ine
Ca
re i
nit
iati
ve
wil
l re
qu
ire
su
bst
an
tia
l
pla
nn
ing
to r
efi
ne
a p
rog
ram
mo
de
l,
an
d s
tro
ng
en
ga
ge
me
nt
of
a p
ote
nti
all
y l
arg
e n
um
be
r o
f
inte
rest
ed
co
ntr
act
ors
an
d s
ub
con
tra
cto
rs.
4/2
7/2
01
01
3
Sta
keh
old
er
En
gag
em
en
t
Ba
sed
on
th
e R
FI
resp
on
se a
nd
in
form
al
pre
lim
ina
ry
ou
tre
ach
, th
e D
ep
art
me
nt
fin
ds
tha
t a
dvo
cate
s,
con
sum
ers
, D
HH
S c
lin
ica
l p
rog
ram
dir
ect
ors
,
po
ten
tia
l co
ntr
act
ors
an
d p
rovid
ers
are
wil
lin
g t
o
pa
rtic
ipa
te in
sta
keh
old
er
pro
cess
es
to e
nsu
re t
ha
t p
art
icip
ate
in
sta
keh
old
er
pro
cess
es
to e
nsu
re t
ha
t
an
y in
itia
tive
wil
l fo
cus
no
t o
nly
on
slo
win
g t
he
gro
wth
of
spe
nd
ing
, b
ut
als
o o
n i
mp
rovin
g m
em
be
r
ou
tco
me
s.
To e
nsu
re a
me
an
ing
ful
pro
cess
, re
sou
rce
s
wo
uld
ne
ed
to
be
de
dic
ate
d t
o e
ng
ag
em
en
t.
4/2
7/2
01
01
4
Sta
te A
dm
inis
tra
tive
Re
sou
rce
s a
nd
Ca
pa
city
Th
e D
ep
art
me
nt
fin
ds
its
curr
en
t a
dm
inis
tra
tive
reso
urc
es
insu
ffic
ien
t to
pe
rfo
rm t
he
fid
uci
ary
an
d q
ua
lity
ove
rsig
ht
fun
ctio
ns
inh
ere
nt
in
risk
-ba
sed
Me
dic
aid
ma
na
ge
d c
are
. F
ea
sib
ilit
y
risk
-ba
sed
Me
dic
aid
ma
na
ge
d c
are
. F
ea
sib
ilit
y
de
pe
nd
s o
n S
tate
go
ve
rnm
en
t’s
ab
ilit
y a
nd
wil
lin
gn
ess
to
in
ve
st i
n s
tart
-up
act
ivit
ies
an
d
ma
ke lo
ng
-te
rm c
om
mit
me
nts
to
ad
eq
ua
te
ad
min
istr
ati
on
of
the
pro
gra
m.
4/2
7/2
01
01
5
Fed
era
l Au
tho
rity
Eli
gib
ilit
y G
rou
pV
olu
nta
ry E
nro
llm
en
tM
an
da
tory
En
roll
me
nt*
Pa
ren
ts a
nd
Ch
ildre
nSt
ate
Pla
n A
me
nd
me
nt
Sta
te P
lan
Am
en
dm
en
t
SSI
(bu
t n
ot
du
ally
elig
ible
for
Me
dic
are
,n
ot
spe
cia
l
ne
ed
s ch
ild,
no
t In
dia
n
Sta
te P
lan
Am
en
dm
en
tSt
ate
Pla
n A
me
nd
me
nt
Du
ally
elig
ible
, sp
eci
al
ne
ed
s ch
ild
Sta
te P
lan
Am
en
dm
en
tSe
ctio
n 1
91
5(b
) w
aiv
er
or
Sect
ion
11
15
wa
ive
r
SSI,
wit
h lo
ng
-te
rmse
rvic
es
an
d s
up
po
rts
Exi
stin
g 1
91
5(c
) w
aiv
er,
con
curr
en
t w
ith
ab
ove
Exi
stin
g 1
91
5(c
) w
aiv
er,
con
curr
en
t w
ith
ab
ove
The Department finds it feasible to obtain federal perm
ission to implement risk-
based contracts in M
aineCare, particularly if no expansion of the population is
sought, thereby avoiding a Section 1115 waiver application.
*Assu
me
s c
ho
ice
of a
t le
ast 2
pla
ns.
4/2
7/2
01
01
6
Ra
ng
e o
f Fe
de
ral A
uth
ori
ty O
pti
on
s
Ea
sie
rto
Ob
tain
H
ard
er
to O
bta
in
Few
er
De
sig
n O
pti
on
s
Mo
re D
esi
gn
Op
tio
ns
Sta
te P
lan
Am
en
dm
en
t;
Ma
na
ged
ca
re
wa
ive
rs (
eit
he
r se
lf-
Sect
ion
11
15
Re
sea
rch
an
d
Am
en
dm
en
t;
Sect
ion
19
15
(a)
Sta
tuto
ry A
uth
ori
ty
wa
ive
rs (
eit
he
r se
lf-
sta
nd
ing
or
incl
ud
ed
wit
h h
om
e a
nd
com
mu
nit
y b
ase
d
wa
ive
rs s
uch
as
MR
wa
ive
r)
Re
sea
rch
an
d
De
mo
nst
rati
on
Wa
ive
r
4/2
7/2
01
01
7
Lite
ratu
re R
evi
ew
: Su
mm
ary
of
Ris
k-b
ase
d
Me
dic
aid
Ma
na
ge
d C
are
Ou
tco
me
s
Pre
po
nd
era
nce
of
pe
er-
rev
iew
ed
lit
era
ture
re
po
rts
tha
t m
an
ag
ed
ca
re i
s a
sso
cia
ted
wit
h..
…g
rea
ter
like
liho
od
of
a
usu
al s
ou
rce
of
care
fo
r m
em
be
rs
… le
ss
em
erg
en
cy
de
pa
rtm
en
t u
se
… r
ed
uct
ion
in
pre
ven
tab
le
ho
spit
al
ad
mis
sio
ns
… g
rea
ter
smo
kin
g
cess
ati
on
an
d
pre
na
tal c
are
...
gre
ate
r u
se o
f
com
mu
nit
y
serv
ice
s, a
nd
less
use
of
care
fo
r m
em
be
rsa
dm
issi
on
sp
ren
ata
l ca
re
am
on
g
pre
gn
an
t
wo
me
n
less
use
of
inst
itu
tio
na
l
serv
ice
s a
mo
ng
pe
rso
ns
wit
h
lon
g-t
erm
sup
po
rt n
ee
ds
A m
ore
lim
ited n
um
ber
of stu
die
s f
ound a
dvers
e o
utc
om
es,
inclu
din
g o
ne in
whic
h e
merg
ency d
epart
ment
use w
ent
up,
and a
noth
er
in w
hic
h p
regnant
wom
en d
id b
ett
er
in f
ee-f
or-
serv
ice t
han in m
anaged c
are
.4
/27
/20
10
18
Pro
ject
ed
Im
pa
ct o
n Q
ua
lity
an
d
He
alt
h O
utc
om
es
Th
e D
ep
art
me
nt
fin
ds
tha
t th
e i
mp
act
of
risk
-ba
sed
ma
na
ge
d c
are
on
qu
ali
ty a
nd
he
alt
h o
utc
om
es
wil
l b
e
po
siti
ve
if
the
pro
gra
m p
lace
s a
str
on
g e
mp
ha
sis
on
me
asu
rin
g q
ua
lity
. T
yin
g p
aym
en
ts t
o q
ua
lity
is
an
m
ea
suri
ng
qu
ali
ty.
Tyin
g p
aym
en
ts t
o q
ua
lity
is
an
imp
ort
an
t st
rate
gy t
ha
t e
nh
an
ces
the
fo
cus
on
qu
ali
ty.
4/2
7/2
01
01
9
Na
tio
na
l Fin
din
gs
on
Sa
vin
gs
•Sa
vin
gs
ran
ge
of
.5%
to
20
%
•Sa
vin
gs
gre
ate
r fo
r o
lde
r p
ers
on
s a
nd
pe
rso
ns
wit
h d
isa
bili
tie
s th
an
fo
r p
are
nt
an
d c
hild
ren
•Sa
vin
gs
gre
ate
r in
urb
an
th
an
in
ru
ral a
rea
s•
Savi
ng
s g
rea
ter
in u
rba
n t
ha
n i
n r
ura
l are
as
•Sa
vin
gs
gre
ate
r in
ris
k-b
ase
d t
ha
n in
PC
CM
•Sa
vin
gs
de
rive
pri
ma
rily
fro
m r
ed
uci
ng
inp
ati
en
t u
se
4/2
7/2
01
02
0
Savi
ng
s Fa
cto
rs U
sed
in A
na
lysi
s
Pre
limin
ary
-Su
bje
ct t
o R
FPA
rea
of
Sta
teM
an
age
dC
are
Sa
vin
gs
Fact
or
Pa
ren
tsa
nd
Ch
ildre
nO
lde
r P
ers
on
sa
nd
Pe
rso
ns
wit
h D
isa
bili
tie
s
Urb
an
Co
un
tie
s8
% t
o 1
2%
10
% t
o 1
4%
Ru
ral C
ou
nti
es
6%
to
8%
8%
to
10
%
Urb
an:
Andro
scoggin
, C
um
berland,
Kennebec,
Penobscot,
Sagadahoc, Y
ork
Rura
l: A
ll oth
er
counties
So
urc
e: D
elo
itte
Actu
arie
s4
/27
/20
10
21
Est
ima
ted
Ne
t Sa
vin
gs
by
Sce
na
rio
Sce
na
rio
Pa
ren
ts
an
d
Ch
ild
ren
,
Urb
an
Pa
ren
ts
an
d
Ch
ild
ren
,
Ru
ral
Old
er
Pe
rso
ns,
Pe
rso
ns
wit
h
Dis
ab
ilit
ies,
Urb
an
Old
er
Pe
rso
ns,
Pe
rso
ns
wit
h
Dis
ab
ilit
ies,
Ru
ral
Est
. A
nn
ua
l
Sa
vin
gs
(mil
lio
ns)
Gro
ss
1M
an
da
tory
Ma
nd
ato
ryM
an
da
tory
Ma
nd
ato
ry$
33
-$
71
1M
an
da
tory
Ma
nd
ato
ryM
an
da
tory
Ma
nd
ato
ry$
33
-$
71
2M
an
da
tory
Ma
nd
ato
ryM
an
da
tory
Vo
lun
tary
$3
0 -
$6
6
3M
an
da
tory
Ma
nd
ato
ryV
olu
nta
ryV
olu
nta
ry$
24
-$
55
4M
an
da
tory
Vo
lun
tary
Vo
lun
tary
Vo
lun
tary
$2
1 -
$4
7
Based o
n F
Y 0
8 d
olla
rs. E
stim
ate
s d
o n
ot account fo
r cla
im c
ost tr
end r
ate
s o
r pote
ntial ra
te c
uts
.
Savin
gs a
ssum
e e
nro
llment of all
gro
ups e
xcept dually
elig
ible
and M
R w
aiv
er
mem
bers
.
Urb
an: A
ndro
scoggin
, C
um
berland, K
ennebec, P
enobscot, S
agadahoc, Y
ork
.
Rura
l: A
ll oth
er
counties.
4/2
7/2
01
02
2
Imp
lem
en
tati
on
Co
st E
stim
ate
sTa
skYe
ar
1 P
lan
nin
g C
ost
s (F
Y 1
1)
Ma
tch
Sta
te (
00
0’s
)
To
tal (
00
0’s
)
Sta
keh
old
er
En
gag
em
en
t5
0/5
0
$
25
0
$
5
00
Mo
de
l De
sig
n5
0/5
0
$
25
0$
5
00
Sta
te P
lan
Am
en
dm
en
ts/W
aiv
ers
50
/50
$
2
50
$
50
0
Re
qu
est
-fo
r-P
rop
osa
ls;
Issu
e a
nd
Eva
lua
te5
0/5
0
$
25
0
$
5
00
Act
ua
ria
l Ra
te D
eve
lop
me
nt
50
/50
$
37
5
$
7
50
Act
ua
ria
l Ra
te D
eve
lop
me
nt
50
/50
$
37
5
$
7
50
Info
rma
tio
n S
yste
ms
Up
da
tes
90
/10
$
1
00
$ 1
,00
0
Qu
ali
tyP
rog
ram
De
velo
pm
en
t6
0/4
0
$
24
0$
4
00
En
roll
me
nt
Bro
ker
50
/50
$
1
25
$
25
0
Co
ntr
act
De
velo
pm
en
t/M
an
ag
em
en
t5
0/5
0
$
12
5$
2
50
TO
TAL
Imp
lem
en
tati
on
Co
sts,
FY
11
$ 1
,96
5
$
4,6
50
Re
all
oca
tio
n o
f e
xist
ing
co
ntr
act
an
d s
taff
ing
re
sou
rce
s5
0/5
0
($
42
5)
($
85
0)
Ne
t N
ew
Ne
ed
s, F
Y 1
1$
1,5
40
$ 3
,80
0
4/2
7/2
01
02
3
Illu
stra
tive
On
go
ing
Ma
na
ge
d C
are
Op
era
tio
na
l Co
sts
Ta
sks
Sta
te
Re
sou
rce
s
Ou
tsid
e
Re
sou
rce
sM
atc
hR
ate
Sta
te
(00
0’s
)
To
tal
(00
0’s
)
De
fin
e O
pe
rati
on
al M
od
el
��
50
/50
$
15
0$
3
00
Sta
keh
old
er
En
ga
ge
me
nt
��
50
/50
$
50
$
10
0
De
velo
pm
en
t a
nd
Su
bm
issi
on
of
Sta
te
Pla
n A
me
nd
me
nts
/Wa
ive
rs�
�5
0/5
0$
5
0$
1
00
Ra
te D
eve
lop
me
nt
�5
0/5
0$
1
25
$
25
0
Ad
dit
ion
al O
pe
rati
on
alU
pd
ate
s�
�7
5/2
5
$
50
$
2
00
Ext
ern
al Q
ua
lity
Re
vie
w O
rga
niz
ati
on
(EQ
RO
) /I
nte
rna
l Qu
alit
yM
on
ito
rin
g�
�6
0/4
0$
1
40
$
35
0
En
rollm
en
t B
roke
r�
50
/50
$
50
$
1
00
Co
ntr
act
De
velo
pm
en
t/ M
an
ag
em
en
t�
50
/50
$
10
0
$
20
0
Sa
vin
gs
on
exi
stin
g c
are
ma
na
ge
me
nt,
ass
ess
me
nt
an
d u
tili
zati
on
re
vie
w
Ne
t a
nn
ua
l o
pe
rati
on
al s
av
ing
s
$
71
5
($2
,10
0)
($1
,38
5)
$ 1
,60
0
($6
,30
0)
($4
,70
0)
4/2
7/2
01
02
4
Re
com
me
nd
ati
on
s -
po
pu
lati
on
s a
nd
serv
ice
s•
Pro
cee
d w
ith
pro
gra
m d
esi
gn
an
d c
om
pe
titi
ve
pro
cure
me
nt
•P
ha
se-i
n p
op
ula
tio
ns:
–
I: P
are
nts
an
d C
hild
ren
, m
an
da
tory
en
rollm
en
t 7
/1/1
1
–II
: S
SI,
no
n-d
ua
l, m
an
da
tory
en
rollm
en
t 7
/1/1
2–
II:
SSI
, n
on
-du
al,
ma
nd
ato
ry e
nro
llme
nt
7/1
/12
–II
I: D
ua
ls a
nd
Me
nta
l Re
tard
ati
on
Wa
ive
r, v
olu
nta
ry
en
rollm
en
t 7
/1/1
3
•C
on
curr
en
t w
ith
Ph
ase
I,
de
velo
p a
vo
lun
tary
pro
gra
m
for
pe
rso
ns
wit
h A
cqu
ire
d B
rain
In
jury
•Se
ek
full
ris
k a
rra
ng
em
en
ts w
ith
MC
Os
an
d/o
r A
CO
s w
ith
ali
gn
ed
pro
vid
er/
pa
yor
ince
nti
ves
•In
vest
in u
p f
ron
t a
nd
on
go
ing
infr
ast
ruct
ure
4/2
7/2
01
02
5
Illu
stra
tive
Tim
elin
e f
or
Ph
ase
d I
mp
lem
en
tati
on
of
Ma
na
ged
Ca
re/A
cco
un
tab
le C
are
Org
an
iza
tio
n
Phase
SFY2012
SFY2013
SFY2014
�Phase I
TANF, TANF-related
, an
d CHIP fo
r Cou
nty
Group
A
�Phase II
�Phase II
TANF, TANF-related
, an
d CHIP fo
r Cou
nty
Group
B and
SSI
Group
s A and
B
�Phase III
(Optional)
Dua
l Eligibles
4/2
7/2
01
02
6
Illu
stra
tive
Tim
elin
e f
or
Imp
lem
en
tati
on
of
Ph
ase
I
Task
Q4 -
SFY10
2010
2011
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
�Project Kick-off:
Define Ope
rationa
l Mod
el
�Policy Develop
men
t and
Ana
lysis
�Initial CMS Discussions
and Technical Assistance
�Develop
and
Sub
mit State
Plan Amen
dmen
ts
Stakeho
lder Eng
agem
ent –
�Stakeho
lder Eng
agem
ent –
Ope
rationa
l Discussions
�Develop
and
Evaluate
RFPs
�State Plan / W
aiver
Amen
dmen
t App
roval
�Pub
lic Notice an
d Com
men
t Process
�Develop
and
Estab
lish
Target Rates
�Ong
oing
Implem
entation
with Provide
rs
�Implem
ent P
rogram
4/2
7/2
01
02
7
Wh
at
are
th
e p
ote
nti
al b
en
efi
ts f
or
Ma
ine
?
•C
on
stru
ctiv
e e
nga
ge
me
nt
an
d in
teg
rati
on
of
pro
vid
ers
, m
em
be
rs
•Im
pro
ved
acc
ess
an
d q
ua
lity
•Su
sta
ina
bili
ty•
Sust
ain
ab
ility
•P
op
ula
tio
n h
ea
lth
fo
cus
•M
ain
eC
are
/DH
HS
be
com
e s
tra
teg
ic a
nd
pro
act
ive
4/2
7/2
01
02
8
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