Update: MCO Provider Agreements

Commonwealth Coordinated Care

Last week, the Virginia Health Care Association was informed verbally by leadership of the Department of Medical Assistance Services (DMAS) that all proposed provider agreements between health plans and nursing facilities under Virginia’s Commonwealth Coordinated Care program must be submitted by the managed care organization (MCO) to DMAS for review and approval prior to execution.  VHCA’s Managed Care Committee is working with DMAS to ensure that provider agreements contain essential provisions that will allow facilities to provide post-acute and long term care services to dual eligible beneficiaries free of unnecessary administrative oversight and require health plans to pay providers fairly and promptly for those services.

Despite this assurance from DMAS, we understand that some VHCA member facilities are continuing to receive provider agreements from MCOs with requests that they be signed and returned promptly.  During a conference call with DMAS officials on August 8th, Department representatives confirmed their new requirement that provider agreements developed by MCOs must be submitted to DMAS for review and approval.  As of today no MCO provider agreement has been approved for distribution to nursing facility providers.  Any facility receiving a provider contract should wait for DMAS to approve the contract.

Since the three health plans that DMAS has announced will be their partners in the initiative are not likely to receive rate information from the Centers for Medicare and Medicaid Services for at least several weeks, it is difficult to understand why the MCOs want to finalize contracts in advance of knowing this important information.  Payment terms are a core component of any properly executed contract.  During a mid-July meeting between representatives of VHCA’s Managed Care Committee and DMAS, managers with overall responsibility for the Dual’s initiative indicated that a four to six week window beginning in mid-September would represent the best timeframe for nursing facilities to work with MCOs to execute provider agreements.

To assist our members with their analysis of provider agreements, VHCA is developing key contract provisions and related contract language.  This resource is expected to be finalized and available within the next two weeks.  Please be on the lookout for more information in future CareConnection issues.  Members with questions are encouraged to contact VHCA.