South Carolina

South Carolina Capitated Financial Alignment Model Demonstration (Healthy Connections Prime)

SPOTLIGHT & RELEASES

On October 25, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that the state of South Carolina will partner with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.

Under the demonstration, called Healthy Connections Prime, South Carolina and CMS will contract with Medicare-Medicaid plans to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees. 

Key Dates

October 25, 2013 - CMS and South Carolina sign MOU

September 15, 2014 - CMS, South Carolina, and participating plans execute three-way contract 

February 1, 2015 - Start of opt-in enrollment

April 1, 2016 - Start of passive enrollment

November 1, 2017 - CMS, South Carolina, and participating plans execute three-way contract amendment

July 1, 2018 - CMS, South Carolina, and participating plans execute three-way contract amendment

July 1, 2020 - CMS, South Carolina, and participating plans execute three-way contract amendment

January 1, 2022 - CMS, South Carolina, and participating plans execute updated three-way contract

August 1, 2023 - CMS, South Carolina, and participating plans execute updated three-way contract

More information from CMS:

• Fact Sheet
• Three-Way Contract (PDF)
  • Summary of Contract Changes (01/01/2022) (PDF)
• Three-Way Contract (08/01/2023) (DOCX)
  • Summary of Contract Changes (08/01/2023) (PDF)
• MOU (PDF)
• State Proposal (PDF) 
• Third Evaluation Report for the South Carolina capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (12/20/2023)
  • Findings at a Glance
• Second Evaluation Report for the South Carolina capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (01/11/2022)
  • Findings at a Glance
• First Evaluation Report for the South Carolina capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (09/24/2019)
• Readiness Review Tool (PDF)
• South Carolina Evaluation Design Plan (PDF)
• Letter of Intent to Extend Scheduled End Date (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6 (PDF)
• South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 7 (PDF)

Information for Plans:

• All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.

Information for Beneficiaries and Providers:

• South Carolina Healthy Connections Prime Continuity of Care Provisions (PDF)
• Healthy Connections Prime Ombudsman Program
• South Carolina Healthy Connections Prime Provider Frequently Asked Questions (FAQs) (PDF)

Information from the state of South Carolina:

• Healthy Connections Prime

Funding Support:

• Beneficiary Counseling & Ombudsman Programs

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