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DHS Virtual Pace Initiative

Wisconsin Department of Health Services has released a draft proposal for the provision of integrated care to people who are eligible for Medicare and Medicaid. The proposal will be available for public review for thirty days.

In 2011, Wisconsin was competitively selected to receive funding through CMS’ State Demonstrations to Integrate Care for Dual Eligible Individuals. As part of this Demonstration, CMS provided support to the State to design a demonstration proposal that describes how it would structure, implement, and monitor an integrated delivery system and payment model aimed at improving the quality, coordination, and cost-effectiveness of services for dual eligible individuals. Through the demonstration proposal, the State must demonstrate its ability to meet or exceed certain CMS established standards and conditions including beneficiary protections. These standards and conditions include factors such as beneficiary protections, stakeholder engagement, and network adequacy among others. In order for CMS to determine whether the standards and conditions have been met, States are asked to submit a demonstration proposal that outlines their proposed approach for integrating care for dual eligible individuals. The Wisconsin Department of Health Services has submitted this proposal for CMS review.

As part of the review process, CMS will seek public comment through a 30-day notice period. During this time interested individuals or groups may submit comments to help inform CMS’ review of the proposal.

CMS will make all decisions related to the implementation of proposed demonstrations following a thorough review of the proposal and supporting documentation. Further discussion and/or development of certain aspects of the demonstration (e.g., quality measures, rate methodology, etc.) may be required before any formal agreement is finalized.

Publication of this proposal does not imply CMS approval of the demonstration. Invitation for public comment: We welcome public input on this proposal. To be assured consideration, please submit comments by 5 p.m., May 31, 2012. You may submit comments on this proposal to WI-MedicareMedicaidCoordination@cms.hhs.gov.