The State Innovation Models (SIM) initiative partnered with states to advance multi-payer health care payment and delivery system reform models. Each state-led model aimed to achieve better quality of care, lower costs, and improved health for the population of the participating states or territory. The initiative tested the ability of state governments to utilize policy and regulatory levers to accelerate health system transformation to meet these aims. SIM supported over half of states representing 61 percent of the U.S. population: 38 total awardees included 34 states, three territories, and the District of Columbia.
Through two rounds, SIM supported model “test” awardees and model “design” awardees by providing funding, learning tools, and expert technical assistance.
- Model Test Awards allowed states to implement and test strategies for health system transformation that met the specific needs of their state’s residents.
- Model Design and Pre-Test Awards allowed states and territories to plan and design strategies for health system transformation that met the specific needs of their state’s residents.
Award recipients engaged a diverse group of stakeholders, including public and commercial payers, providers, and consumers, in order to develop or implement a state innovation plan. The state’s innovation plan outlined its strategy to use all available levers to transform its health care payment and delivery system through multi-payer reform and other state-led initiatives.
Round One Awards
In Round One of the SIM Initiative, the CMS Innovation Center invested nearly $300 million to allow 25 states to design or test innovative health care payment and service delivery models in the form of Model Design, Model Pre-Test, and Model Test awards.
Six states received over $250 million in Round One Model Test investments to implement their state innovation plans.
Sixteen states received Round One Model Design investments to produce a state innovation plans.
Round One Model Pre-Test Awards
Three states received Round One Model Pre-Test investments to continue to develop and refine their state innovation plans prior to implementation.
Round Two Awards
In Round Two, the SIM initiative invested over $660 million to support 32 awardees (28 states, three territories, and the District of Columbia) as they developed or implemented their state innovation plans.
Eleven states received a total of over $620 million in Round Two Model Test investments to implement their state innovation plans.
Twenty-one awardees received Round Two Model Design investments to design or further refine their state innovation plans.
Medicare Participation Guidance
To assist states in developing proposals for Medicare participation in their models, we issued the following guidance:
- State Innovation Models: Updated Guidance on Medicare Alignment in Multi-Payer Models (October 2017) (PDF)
- State Innovation Models: Medicare Alignment in Multi-Payer Models Guidance (PDF)
- State Innovation Models: Medicare Participation in State-Sponsored Models (PDF)
SIM Evaluation Reports
Annual federal evaluations are completed for each Round of the State Innovation Models initiative.
- State Innovation Models Initiative: Model Design and Pre-Test Round One final evaluation report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One first annual report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One second annual report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One third annual report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One fourth annual report (PDF)
- State Innovation Models Initiative: Model Test Awards Round One fifth annual report (PDF)
- State Innovation Models Initiative: Model Design Awards Round Two final evaluation report (PDF)
- State Innovation Models Initiative: Model Test Awards Round Two First Annual Report (PDF)
- State Innovation Models Initiative: Model Test Awards Round Two Second Annual Report (PDF)
- State Innovation Models Initiative: Model Test Awards Round Two Third Annual Report (PDF)
- State Innovation Models Initiative: Model Test Awards Round Two Final Annual Report (PDF)
Request for Information
On September 8, 2016, CMS sought input from all interested parties on the concepts related to the evolution of the SIM initiative. The comment submission period closed on October 28, 2016.
- State Innovation Models Initiative: Request for Information (RFI) (PDF)
- State Innovation Models Initiative: Public Comments in response to Request for Information (RFI) (PDF)
- State Innovation Models Initiative: Fact Sheet
- State Innovation Models Initiative: Request for Information Listening Session slides (PDF)
Additional Information
For additional information, contact the State Innovation Models team at stateinnovations@cms.hhs.gov.