Update on DMAS Dual Eligible Integration Pilots

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Cindi Jones, Director of the Department of Medical Assistance Services (DMAS), recently announced that Virginia plans to move forward with three geographic pilot programs designed to better coordinate the care provided to Medicare-Medicaid enrollees.  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.  According to Ms. Jones, DMAS is planning to pursue pilot programs that would automatically enroll all dual eligible beneficiaries within the designated geographic regions and that an opt-out provision would likely be available.

DMAS plans to hold two kick-off meetings in Richmond on March 21st.  The first meeting will be held from 10:00 AM - 12:15 PM and will be open to all interested parties and will provide an overview of the Demonstration.  DMAS will allocate time slots for interested parties to present public comments during this meeting.  Subsequent meetings will provide for more in-depth exchanges with specific interest groups.  In addition to the series of stakeholder meetings, the draft Demonstration proposal will be posted by DMAS for public comment for thirty days prior to submission to the Medicare and Medicaid Coordination Office (MMCO), and an additional thirty day comment period will be provided by MMCO after submission.  If DMAS’ proposal is accepted by MMCO, there will be additional opportunities for stakeholder input throughout the implementation of the Demonstration, including an advisory group.  Additional information about the March 21st meetings is available here.

VHCA staff members are communicating regularly with DMAS and other groups in connection with the planning and implementation of care coordination initiatives in Virginia.  An 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.