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Centers for Medicare and Medicaid Innovation - Grants in Ohio

State Innovation Models initiative

The Centers for Medicare and Medicaid Innovation announced on Feb. 21, 2013 that Ohio was one of only 16 states to receive Model Design funding for the State Innovation Models (SIM) initiative.  The State of Ohio received up to $3,000,000 to develop a State Health Care Innovation Plan.  Ohio was one of only two states to receive the maximum award amount.  Ohio used the SIM grant to develop a plan to expand the use of patient-centered medical homes and episode-based payments for acute medical events to most Ohioans who receive coverage under Medicaid, Medicare and commercial health plans. The Governor’s Office of Health Transformation led the design team in partnership with the Governor’s Advisory Council on Payment Innovation, which includes representatives from prominent Ohio employers, health plans, health systems and consumer advocates. More details are available on the CMMI website.   Read the Ohio press release on the Office of Health Transformation website.  During the six-month Planning period, the Governor's Office of Health Transformation (OHT) hosted 100+ health experts in 50+ design meetings.  This work is summarized in Ohio's State Health Care Innovation Plan, which OHT submitted to the federal government on November 18 as the final step in the design process and the first step toward testing new payment models.

State Healthcare Innovation Plan

Vision for Payment Innovation

On May 22, 2014, CMMI announced the second round of SIM funding.  On July 18, 2014, Ohio submitted the State Innovation Model (SIM) Testing grant application for innovative payment and service delivery models for Medicaid, state employee, and commercial health plan populations.

Ohio's SIM Testing Grant Application

Letters of Support

More Information

On December 16, 2014 Ohio was awarded a $75 million four-year State Innovation Models (SIM) testing grant to implement enhanced primary care and value-based episode payment models in partnership with Ohio's largest commercial health insurers.

Ohio's Award Letter

CMS Round 2 Funding description

 

Comprehensive Primary Care Initiative

Click Here to access a map of the PCMH practices included in the Comprehensive Primary Care Initiative.

The Center for Medicare and Medicaid Innovation, through a competitive application process, selected practices in 7 localities across the country to participate in their Comprehensive Primary Care initiative (CPCi). CPCi is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care physicians who better coordinate care for their patients. Participating primary care practices will be given resources to better coordinate primary care for their Medicare patients.

On April 11, 2012, CMMI announced that Ohio’s Cincinnati-Dayton region was one of the seven markets selected to participate in the CPC initiative. The Ohio-Kentucky designated area contains 75 primary care practices, 61 of which are located in Ohio, with 261 providers and an estimated 44,500 Medicare beneficiaries. The region is composed of the following 14 counties: Adams, Butler, Brown, Champaign, Clark, Clermont, Clinton, Greene, Hamilton, Highland, Miami, Montgomery, Preble and Warren.

Access more information about the Ohio & Kentucky: Cincinnati-Dayton Region, including a provider map and details about the practices HERE.

CMMI has indicated the following eligibility criteria for applications:

  • Geographically located in a selected CPCi market
  • Willingness to transform to meet five key elements of comprehensive primary care
  • Submits claims using the CMS 1500 form
  • Does not participate in another Medicare shared savings program
  • Serves a minimum of 150 Medicare fee-for-service beneficiaries

Additionally, use of an electronic health records system, any primary care medical home recognitions, having at least 60 percent of revenue generated by participating payers, and any participation in practice transformation activities in the past three years will be heavily favored in the selection process.

To learn more about the Comprehensive Primary Care initiative by the Center for Medicare and Medicaid Innovation Click Here.

To access the provider maps from the Ohio Department of Health and view a map of the selected region, Click Here, and utilize the drop down menus.

 

Federally Qualified Health Center (FQHC) Advanced Primary Care Practice

This demonstration project, operated by the Centers for Medicare and Medicaid Services (CMS) in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to coordinate and improve care for up to 195,000 Medicare patients.

Participating FQHCs are expected to achieve Level 3 patient-centered medical home recognition, help patients manage chronic conditions, as well as actively coordinate care for patients. To help participating FQHCs make these investments in patient care and infrastructure, they will be paid a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In return, FQHCs agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA).

CMS and HRSA will provide technical assistance to help FQHCs achieve these goals.

Learn more about the Federally Qualified Health Center Advanced Primary Care Practice demonstration Here.

 

Updated 12/17/2014