DMAS Moving Forward With Dual Eligible Integration Pilots

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During last week’s VHCA/VCAL Legislative Conference in Richmond, Cindi Jones, Director of the Department of Medical Assistance Services (DMAS), announced to attendees that Virginia plans to move forward with three geographic pilot programs designed to better coordinate the care provided to Medicare-Medicaid enrollees.  According to information provided by the American Health Care Association (AHCA), 23 states are either planning for some form of Medicaid managed care for long term care services or have already implemented managed care programs.

While formal announcements have not yet been made, Ms. Jones shared that DMAS plans to hold two kick-off meetings in Richmond on March 21st.  A general meeting open to the public will be held in the morning followed by a nursing facility and hospital specific session that afternoon.  It is our understanding that DMAS intends to pursue managed care pilot programs in the Northern Virginia, Richmond/Charlottesville and Tidewater regions of the Commonwealth.  Under the pilot programs, long term care services provided to dual eligible (Medicare-Medicaid) enrollees would likely be coordinated and paid for by managed care organizations who have been awarded a three-way contract between the Center for Medicare and Medicaid Services (CMS), DMAS and the health plan.  Ms. Jones indicated that DMAS is planning to pursue pilot programs that would automatically enroll all dual eligible beneficiaries within the designated geographic regions and that a beneficiary opt-out provision would likely be available.

In addition to the DMAS pilot projects, two recent actions in the Commonwealth also highlight the increased focus on the need for better care coordination within the dual eligible beneficiary population.  Two pieces of legislation were introduced in the 2012 Virginia General Assembly addressing care and services provided to Medicare-Medicaid enrollees.  Senate Bill 659 was introduced by Senator Steve Martin on behalf of AmeriGroup, a Virginia Beach-based managed care organization.  The bill, which would have directed DMAS to implement managed care, failed to gain support and was pulled by the patron before being heard in committee.  Additionally, budget amendments submitted by Senator Steve Newman and Delegate Chris Stolle provide additional guidance to DMAS as the Department works to implement care coordination programs including the three geographic pilots.

VHCA staff members are communicating regularly with DMAS and other groups in connection with the planning and implementation of care coordination initiatives in Virginia.  A VHCA ad hoc committee has been assembled to evaluate the programs now being considered by DMAS and will meet in early April with Cindi Jones.  Members will be receiving regular updates on this topic in future CareConnection issues.