Medicare/Medicaid Program (“MMP”) Readiness and Implementation Services
As health care reform through the Affordable care Act (“ACA”) and other transformative programs continue unabated, the populations of government program beneficiaries who are eligible for both Medicare and Medicaid have gained in visibility. The programs and benefit plans established to serve this often compromised population have evolved in recent years with the advent of demonstration programs overseen by CMS. These demonstration programs, often termed as Medicare/Medicaid Programs or MMPs allow for the three way contracting between CMS for Medicare, the State for Medicaid and the private health insurer to provide coverage for the dual eligible population. In advance of the contracting phase however, is an arduous readiness review protocol instituted by the state and CMS which evaluates the prospective health plan contractor’s ability to administer the MMP program effectively and in compliance with the complex program requirements. This readiness review protocol consists of two distinct phases: Phase 1 is a document/desk review of processes and policies and Phase 2 is a comprehensive and intensive onsite program review and system demonstration. It is only after the successful navigation of this readiness review protocol that a health plan would be considered for participation in the MMP.
A key question for health plans wishing to be part of the MMP demonstration is “Are we really ready to pass this arduous review and does our plan infrastructure support the administration of the MMP program?” FTI Consulting’s Health Solutions practice is at the forefront of this process and has unique experience in the readiness review process and operational implementation of MMP programs for health plan contractors. We are an advisor with broad and deep regulatory compliance, operations, and systems expertise that can help your organization in this endeavor.
Health Plans that hold government contracts particularly Medicare Advantage, Part D and Medicaid are used to dealing with significant amounts of federal regulatory and policy requirements for all operational areas. However, the MMP Dual Eligible program requires health plans to administer their benefits under the auspices of two distinct and separate environments which can lead to extreme operational and compliance challenges.