Authority

Authority refers to the specific source (e.g. legislation, executive office, cabinet or Medicaid agency) of the model’s authorization. This category also includes regulatory adjustments (e.g. changes to licensure requirements or data confidentiality rules) made by states to facilitate accountable care models.

 

Alabama
Act 2013-261 became law in June 2013. This legislation calls for Alabama to be divided into regions and that a community-led network coordinates the health care of Medicaid patients in each region, with networks ultimately bearing the risks of contracting with the state of Alabama.

Alabama’s Medicaid agency is seeking an 1115 Waiver from CMS to allow for the implementation of the Regional Care Organizations.

Alaska No known activity at this time.
Arizona No known activity at this time.
Arkansas

Arkansas’ application to the Centers for Medicare & Medicaid Innovation’s State Innovation Models Initiative indicates that CMS approved a State Plan Amendment authorizing this payment model in August 2012.

California
The California Public Employees’ Retirement System (CalPERS) Board of Administration has long-standing authority under state law to contract with health insurance carriers to secure health benefit plans for its enrollees.
Colorado The program was initially authorized and funded as a budget initiative by the Colorado Legislature in FY2009-2010.
Connecticut No known activity at this time.
Delaware No known activity at this time.
District of Columbia No known activity at this time.
Florida No known activity at this time.
Georgia No known activity at this time.
Hawaii The Accountable Healthcare Alliance of Rural Oahu (AHARO) was established via interagency agreement between the three participating Federally Qualified Health Centers in 2010. Contracts with the two participating Medicaid managed care plans support “health care home” standards (additional standards, beyond NCQA patient-centered medical home recognition, for care enabling services, cultural proficiency, community involvement, and workforce and economic development), performance-based reimbursement, and shared savings partnerships.
No known activity at this time.
The Care Coordination Innovations Project is an initiative within the Illinois Department of Healthcare and Family Services to meet a legislative mandate that 50 percent of Medicaid beneficiaries be enrolled in coordinated care by 2015. This mandate—and the definition of “coordinated care”—was passed as part of Public Act 096-1501 in 2011.
Indiana No known activity at this time.
The Iowa Health and Wellness Plan was authorized by Chapter 138 of the Acts of 2013. Iowa has submitted to CMS a request for an 1115 Demonstration Waiver to implement the Iowa Wellness Plan. It is also using funds from a State Innovation Model grant to plan for a multi-payer accountable care organization model.
Kansas No known activity at this time.
Kentucky No known activity at this time.
The Centers for Medicare & Medicaid Services approved a State Plan Amendment to implement Coordinated Care Networks as part of a new Medicaid managed care program, Bayou Health. The State Plan Amendment took effect on February 1, 2012.
MaineCare is developing a State Plan Amendment to authorize the Accountable Communities Initiative.
No known activity at this time.

Chapter 224 of the Acts of 2012 establish a new state agency—known as the Health Policy Commissioner—in the Massachusetts Executive Office of Administration & Finance. The Commission is an independent public entity not subject to supervision or control by other executive offices or departments in Massachusetts. This Commission is granted authority to certify accountable care organizations (ACOs) and responsibility for oversight and monitoring of the ACOs.

No known activity at this time.
 

In 2010, the Minnesota Legislature passed a bill (Minnesota Statutes § 256B.0755) requiring that the Commissioner of Human Services “develop and authorize a demonstration project to test alternative and innovative health care delivery systems, including accountable care organizations that provide services to a specified patient population for an agreed-upon total cost of care or risk/gain sharing payment arrangement.”

 

The Department of Human Services released a Request for Proposals from Health Care Delivery Systems (HCDSs) in the state in September 2011.

 

Minnesota received federal approval to implement the demonstration’s payment reforms under its Medicaid state plan in August 2012.

Mississippi No known activity at this time.
No known activity at this time.
Montana No known activity at this time.
No known activity at this time.
Nevada No known activity at this time.
New Hampshire No known activity at this time.
 

The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration Project was authorized by the passage of P.L. 2011, Ch. 114. The statute specifies that the New Jersey Department of Human Services will establish the demonstration in consultation with the state’s Department of Health and Senior Services.

 

In the authorizing legislation, New Jersey’s legislature announced its intent to “exempt activities undertaken pursuant to the Medicaid ACO Demonstration Project that might otherwise be constrained by State antitrust laws and to provide immunity for such activities from federal antitrust laws through the state action immunity doctrine.”

 

In early October 2012, the Centers for Medicare & Medicaid Services approved New Jersey’s Comprehensive Medicaid Waiver, an 1115 demonstration waiver. The delivery system reforms covered in the waiver include the Medicaid Accountable Care Organization Demonstration Project. 

No known activity at this time.
The certification of accountable care organizations (ACOs) by the New York Department of Health was authorized in March 2011 with the enactment of Chapter 59 of the Chapter Laws of 2011, which created NYS Public Health Code Article 29-E. This law was revised by Chapter 461 of the Chapter Laws of 2012 in October 2012 to better align the state program with the federal Medicare Shared Savings Program and to expand the ACO initiative from a demonstration to a full program.
 
The law also authorizes the New York Department of Health to seek federal approvals and waivers to implement ACOs, including waivers needed to obtain federal financial participation.
No known activity at this time.
North Dakota No known activity at this time.
Ohio No known activity at this time.
No known activity at this time.
 

The Oregon Integrated and Coordinated Health Care Delivery System was authorized by the Oregon legislature in 2011 through House Bill 3650. A second piece of legislation passed in 2012, SB 1580, approved follow-up proposals for Coordinated Care Organization qualification criteria and global budgeting processes developed by the Oregon Health Authority.

 

Section 15 of House Bill 3650 declared the Oregon Legislature’s intent to exempt CCOs from state antitrust laws, and to provide immunity from federal antitrust laws through the state action doctrine.

 

Oregon submitted to the Centers for Medicare & Medicaid Services a Request for Waiver Amendment to the 1115 Demonstration Waiver under which the Oregon Health Plan operates. The state requested a three-year extension of the waiver through October 31, 2016 and sought to maintain authorities included in its existing waiver, such as the authority to contract with managed care entities and to mandatorily enroll and auto-enroll individuals within managed care. The waiver request was approved in July 2012.

No known activity at this time.
No known activity at this time.
South Carolina No known activity at this time.
South Dakota No known activity at this time.
Tennessee No known activity at this time.
Texas

The development and certification of health care collaboratives (HCCs) was authorized by the Texas legislature via SB 7.

 

In addition to certification by the Texas Department of Insurance, potential HCCs must have their applications reviewed by the Attorney General of the state to verify that the collaborative will not likely reduce competition in the market for physician, hospital, or ancillary services and that the pro-competitive benefits of proposed HCCs outweigh the anticompetitive effects of increased market power.

 

SB 7 specified that certified HCC would be provided immunity from federal antitrust laws through the state action doctrine.

Utah is pursuing Accountable Care Organizations (ACOs) in Medicaid under the mandate to introduce new payment methodologies into Medicaid established by SB 180 in 2011.
 
The state originally included its proposal to convert existing managed care contracts into ACO contracts in the Payment & Service Delivery Reform Proposal for an 1115 Demonstration waiver it submitted to CMS in June 2011; this waiver was submitted in accordance with a statutory requirement included in SB 180. While CMS denied this waiver request, it expressed support for the ACO model proposed by the state. The state sought to amend its existing 1915(b) managed care waiver to incorporate the ACO contracting approach.
While Vermont has authority under an existing 1115 Demonstration waiver to implement a shared savings ACO in Medicaid, the state intends to submit a Medicaid State Plan Amendment for its Shared Savings Program.
Virginia No known activity at this time.
No known activity at this time.
No known activity at this time.
Wisconsin No known activity at this time.
Wyoming No known activity at this time.