CMS Seeks Input on State Innovations in Pediatric Alternative Payment Models

twitterHealth care delivery system innovations in Medicaid have primarily focused on adult populations as states seek to improve the quality of care and control costs for beneficiaries with chronic and complex health care needs.  Many innovations in child-serving systems have been integrated into broader state reforms for adults and through Centers for Medicaid and Medicare Services (CMS) initiatives including Medicaid Health Homes, State Innovation Models (SIM), CARE grants for children with medical complexity, and Strong Start for Mothers and Newborns. In spite of these and other advancements, many child health experts have asked for greater attention to the unique needs of children and youth, particularly those with special health care needs, in health care delivery reforms.

An important opportunity to help inform and shape federal approaches to pediatric reforms is now available. Through a recently released Request for Information, CMS is seeking input on the opportunities and challenges to implementing system innovations for children and youth; state needs for support and flexibility to implement models such as Pediatric Accountable Care Organizations; and approaches that can help states best integrate health care among the many systems that serve children, including education, mental health and social services. CMS is exploring the development of a new pediatric health care payment and service delivery model “to facilitate strategies for timely and appropriate delivery of family-centered, community-based, linguistically and culturally appropriate, cost-effective, and integrated services to all children and youth covered by Medicaid and CHIP with an emphasis on those with or at-risk for developmental, social, emotional, or behavioral health challenges, intellectual or physical developmental delays or disabilities, and/or those with complex and/or chronic health conditions…” Stakeholder comments are due to the agency on March 28, 2017 and should be submitted to