Summary: Notice of Funding Opportunity for the Transforming Maternal Health Model
Alice Lam, Jen Eder, and Sherry Dai, Manatt Health
On June 26, 2024 the Centers for Medicare & Medicaid Services (CMS) released the Notice of Funding Opportunity (NOFO) for the Transforming Maternal Health (TMaH). This expert perspective summarizes the key takeaways pertaining to the model. CMS recommends that states submit a letter of intent to apply for the TMaH model and these optional letters of intent are due on August 8, 2024. Applications to participate in the model are due on September 20, 2024. Please also refer to this resource that provides an in-depth summary of the opportunity.
TMaH is 10-year delivery and payment model designed to test whether effective implementation of evidence-informed interventions, sustained by a value-based payment (VBP) model, can improve maternal outcomes and reduce Medicaid and Children’s Health Insurance Program (CHIP) program expenditures.
CMS will select up to 15 state Medicaid agencies (SMAs) to participate in the model. All 50 states are eligible to apply. Each SMA selected to participate will be eligible for up to $17 million over the course of the model, which will begin on January 20, 2025 and conclude on January 19, 2035 (up to $8 million for pre-implementation in model years 1 through 3 and up to $9 million for implementation in model years 4 through 10).
SMAs must propose to implement the model statewide or in a sub-state region specified by ZIP codes (though CMS prefers sub-state implementation for evaluation purposes). SMAs must collaborate with providers, care delivery locations, and partner organizations, including managed care plans, state public health departments, and community-based organizations, to implement the model.
TMaH model initiatives are organized around three pillars: (1) Access, Infrastructure and Workforce; (2) Quality Improvement and Patient Safety; and (3) Whole-Person Care Delivery. The TMaH model includes a three year pre-implementation period and a seven year implementation period. During the pre-implementation period, SMAs will receive technical assistance to help achieve pre-implementation milestones across the model’s 10 required and 8 optional elements that have been shown to improve maternal health outcomes.
Implementation of a VBP model is a required model element and will occur in three phases: (1) payments to providers to support care delivery and infrastructure changes starting no later than model year 3, (2) upside-only performance incentive payments to providers in model year 4, and (3) transition from current maternal care payment methodologies to a VBP approach by the end of model year 5. CMS will lead the design of the VBP model, and SMAs and key stakeholders will have the opportunity to provide input.
To measure the model’s impact, CMS will evaluate: rates of low-risk Cesarean-section; severe maternal morbidity; incidence of low birthweight infants; changes in experience of care for those who are pregnant, giving birth, or postpartum; and changes in Medicaid and CHIP program expenditures.
As noted above, CMS recommends SMAs submit a letter of intent to apply for the Model; these optional letters of intent are due on August 8, 2024. Applications to participate in the TMaH Model are due on September 20, 2024. The anticipated award date is on December 15, 2024.