UPDATE: Commonwealth Coordinated Care

As a reminder to our members and due to its significance, we’re repeating portions of a CareConnection article published on August 1st.  The Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS) continue to move forward with the development and implementation of Virginia’s demonstration for a blended Medicare-Medicaid program for dual eligibles – now known as Commonwealth Coordinated Care (CCC).

During a July advisory committee meeting, DMAS announced that it has informed the three health plans (Humana Health Plan, Inc., VA Premier Health Plan, Inc., and Anthem HealthKeepers, Inc.) the Department intends to contract with under the CCC that each plan must submit proposed provider participation agreements to the Department for review and approval prior to requests for execution with individual providers – including skilled nursing facilities.  This news reinforces earlier VHCA communications to member facilities that it is premature to execute MCO provider agreements at this point in time.  To date, no announcement has been received from DMAS that they have approved individual provider agreements from any of the three health plans.

For nursing facilities, the CCC program represents much more than a demonstration.  Beginning in 2014, 71.4% of Virginia SNFs will begin to provide services to Medicare-Medicaid (duals) beneficiaries under the managed care program as it is now being developed.  

The two major efforts ahead for DMAS and CMS are the completion of readiness reviews for each of the participating MCOs and the development and signing of three-way (CMS/DMAS/MCO) contracts.  As of now, DMAS intends to work toward the completion and execution of the three-way contracts by November of this year.  While no formal start date for the CCC program has been announced, DMAS indicates that dual beneficiaries within the Central and Tidewater regions will be passively enrolled beginning in May of 2014.  

The financial goals of the program are to begin to “bend the cost curve” of expenditure growth associated with Medicare and Medicaid funding for services provided to dual eligible beneficiaries.  DMAS indicates that actuarially determined blended rates to be paid to MCOs now being calculated will be adjusted to reflect required savings of 1.0% in calendar years 2014 and 2015, 2.0% in calendar year 2016 and 4.0% in calendar year 2017.  

Members with questions about the CCC program are encouraged to contact VHCA.  VHCA members attending the Annual Convention in Roanoke will have an opportunity to hear from Jade Gong, a nationally recognized expert in the financing and operations of managed long term care programs, about strategies that providers must consider in determining where and how they will survive in this new environment.