Commonwealth Coordinated Care Update

As a follow-up to a December 2013 meeting of VHCA’s ad-hoc managed care committee, association staff recently met with the Department of Medical Assistance Services (DMAS) to address a number of issues identified by the committee.  An outcome from the January meeting with DMAS was DMAS’ agreement to host a series of additional meetings with all three contracted MCOs and VHCA member representatives to try and work through key operational concerns that must be resolved prior to the Commonwealth Coordinated Care (CCC) launch.  To date, two workgroup meetings have been held focusing on a number of issues including authorizations, preauthorizations, reauthorizations, patient pay, Medicare bad debt, and claims submission and testing. Additional meetings will take place through February and possibly into March to wrap up discussions on these topics as well as to address the overall process surrounding care coordination and the transition/discharge planning process.

We are aware that all three contracted health plans are aggressively pursuing the execution of provider agreements with nursing facilities.  This activity is tied closely with requirements on the part of DMAS and the Centers for Medicare and Medicaid Services (CMS) that health plans demonstrate network adequacy in order to operate within specific regions. At this stage, we urge each VHCA member facility to carefully review all of the information and documents available to them prior to making a decision to sign a specific MCO agreement. It is critical that providers have high comfort and trust levels with the agreements and related documents prior to execution.  The ability to negotiate specific contract provisions that  are critical to a facility’s goal of delivering high-quality services and the expectation that there be a corresponding receipt of adequate payment is significantly diminished once agreements are executed.   

DMAS is reporting that all three health plans have finalized their provider manuals and submitted them to the Department in late January.  While it was our understanding that these manuals were intended to serve as key resource documents and guidance for providers, health plan representatives have recently indicated that the manuals unfortunately do not contain the level of detail necessary to provide specific guidance on a wide range of operational areas.  

We encourage our members to attend this year’s Legislative Conference being held February 18 – 19 at the Omni Richmond Hotel.  The conference agenda is heavily focused on the transition to managed care under the CCC.  Registration information and details are available on our website.  In addition, the VHCA/VCAL website includes a CCC resource library designed to hold documents of interest to our members.

Earlier this week, the Department of Medical Assistance Services (DMAS) released a Commonwealth Coordinated Care (CCC) update.  As announced last month, the launch dates for the CCC, Virginia’s Medicare-Medicaid financial alignment demonstration, were revised slightly from those included in 2013 communications.  Services for beneficiaries passively (automatically) enrolled in the Tidewater Region will begin July 1 and the service start date for Central Virginia beneficiaries will shift to August 1.  Following is the revised enrollment timetable for each region in the Commonwealth:

Tidewater area:

    March 2014: Voluntary enrollment begins
    April 2014: Services/supports begin for those enrolled
    May 2014: Automatic enrollment begins
    July 2014: Services/supports for those automatically enrolled begins

Central Virginia/Richmond area:

    March 2014: Voluntary enrollment begins
    April 2014: Services/supports begin for those enrolled
    June 2014: Automatic enrollment begins
    August 2014: Services/supports for those automatically enrolled begins

Northern Virginia, Roanoke, Charlottesville areas:

    May 2014: Voluntary enrollment begins
    June 2014: Services/supports begin for those enrolled
    August 2014: Automatic enrollment begins
    October 2014: Services/supports for those automatically enrolled begins

DMAS reports that the Department has been working on systems testing during the month of January.  The purpose of this testing is to ensure system readiness and connectivity with each of the Medicare-Medicaid Plans (MMPs or MCOs), the enrollment broker, our mailing contractor, and additional entities for functionality specific to this program. Among the several hundred test cases conducted, the team has verified the system’s capacity to uphold the standards of accuracy and beneficiary choice highlighted in the Three-Way Contract.   

DMAS also reports that its CCC enrollment broker, MAXIMUS, has employed essential personnel to manage the enrollment process.  Lead staff received system training from DMAS this month to prepare their customer service representatives for handling enrollment procedures via the VaMMIS system. MAXIMUS received benefit data including provider networks from the three contracted health plans which they are using to complete the CCC Comparison Charts.  Comparison Charts will include: MMP information, CCC regions, standard provided services, and supplemental benefits offered.  

The MAXIMUS website is currently under development and will be available for viewing by mid-February 2014.  The customer service call center will be available starting March 1, 2014. MAXIMUS call center hours of operation are 8:30 am to 6:00 pm Monday through Friday and the number is (855) 889-5243; the TTY number for the hearing impaired is (800) 817-6608.  

DMAS has formed an internal quality committee to monitor the CCC program with the first meeting held in early January. The newly established committee is made up of staff from DMAS Division of Policy, Long Term Care, and Behavioral & Integrated Care. During the first meeting, the committee finalized its mission, core functions and key tasks for 2014. Moving forward, CCC plans to establish a Learning Collaborative for CCC Quality Improvement as an opportunity to engage both internal and external stakeholders on quality improvement initiatives. Conceptual and operational details for this learning collaborative are currently under development with more information to follow over the coming months.

An evaluation team composed of DMAS staff and representatives of George Mason University has started scheduling interviews and site visits to collect data for the evaluation of the CCC Program.  The team is also developing a survey questionnaire that will be used to examine changes in access, utilization and satisfaction among individuals who use long term services and supports, and it is working with agency management to finalize the evaluation’s scope and objectives.  In addition, the team is meeting on a regular basis to coordinate data collection activities, and it is continuing to work with members of the evaluation advisory committee to discuss issues related to the CCC program.

DMAS also announced that the Department, along with its partners, will be offering a series of Town Hall style meetings to provide education and answer questions about the CCC program.  The Town Hall meetings will include presentations from DMAS and the CCC partnering organizations, including each of the contracted MCOs.  The meetings are intended to provide an opportunity to ask questions and to learn more about how CCC will impact enrollees and connect with providers.  Meeting locations and registration information should be available soon.