Commonwealth Coordinated Care: DMAS Approves Humana Provider Agreements

Late last week, the Department of Medical Assistance Services (DMAS) announced that they had approved templates of Humana’s provider participation agreements under the Commonwealth Coordinated Care (CCC or dual demonstration) program.  This approval included the nursing facility contract.  After discussion with DMAS staff, it appears that the Department has approved two Humana documents, a base contract titled “Ancillary Provider Contract” and a separate Nursing Facility Addendum.  According to DMAS, both documents will be sent to nursing facilities within the five CCC regions that currently do not have a contract with Humana.  Nursing facility providers who currently have a contract with Humana will only be sent the Nursing Facility Addendum.   We are pleased to report that based upon our initial review of the contracts, it appears that Humana has agreed to pay providers no less than the established Medicaid and Medicare rates paid to nursing facilities.  

In late September DMAS announced that the Agency had approved provider agreements submitted by Virginia Premier Health Plan, Inc. including the plan’s nursing facility agreement.  Virginia Premier officials stressed that the approved plan will serve as a template for individual provider agreements and provides the flexibility to incorporate contact provisions that foster innovative and effective approaches for care coordination.  It is our understanding that Virginia Premier continues to work towards the finalization of their nursing facility provider agreement.

Senior DMAS staff indicated last week that the Centers for Medicare and Medicaid Services (CMS) has unofficially shared blended Medicare-Medicaid rates to health plans participating in Virginia’s dual demonstration.  Given that participating plans still do not officially know how much they are going to be paid by CMS and DMAS under the Commonwealth Coordinated Care (CCC) demonstration, we again encourage our members to delay the execution of provider agreements until the plans are able to formally confirm payment details.  

In August, VHCA developed a series of recommended contract provisions that were provided to DMAS in connection with their review and approval of MCO provider agreements.  While we believe that the recommendations have been helpful as DMAS worked with the three health plans to approve their provider agreements, the recommendations should also be a resource to facility members as they prepare to negotiate contracts directly with the plans. We plan to make this resource available to our nursing facility members later this week.