Commonwealth Coordinated Care Update

As communicated yesterday in a broadcast email to our members, the Department of Medical Assistance Services (DMAS) provided the final three-way contract dated December 4, 2013 to VHCA earlier this week.  The three-way contract is the key legal agreement between the federal Centers for Medicare and Medicaid Services (CMS), DMAS and each individual participating health plan necessary to form the Commonwealth Coordinated Care (CCC or dual demonstration) program.

At the current time, the three-way contract has not been executed.  Senior DMAS leadership has indicated that the contract will be signed this month making Virginia the third state in the country to have executed contracts.  VHCA’s Ad-Hoc Managed Care Committee will meet in Richmond next week with representatives of all three health plans selected to participate in the dual demonstration.  The meeting will focus on better understanding how the plans will work collaboratively with nursing facilities to enhance overall care coordination for dual eligible beneficiaries.  A specific focus will be on how key nursing facility operational areas will be impacted under the demonstration.  

VHCA has requested a review of the three-way contract by outside legal counsel to include a summary analysis of issues of significance to nursing facilities.  We are sharing the contract with our members now to allow members to begin their review in connection with consideration of provider participation agreements with health plans under the Commonwealth Coordinated Care program.   We plan to make the legal analysis available within the next several days.

We encourage our members with facility operations within the five CCC demonstration regions to review the three-way contract.  Key areas of interest include Section 2.10 beginning on Page 77 related to provider payment and Section 2.15 starting on Page 109 that addresses provider appeals.

To download and view the three-way contract document as a PDF file, please visit our Commonwealth Coordinated Care Resource Library and select the first document Commonwealth Coordinated Care Final Three-Way Contract (member log-in required).

As a reminder, in late October and November we provided two additional documents also available in the resource library intended to assist our members as they evaluate provider participation agreements with the CCC health plans.  Commonwealth Coordinated Care: Considerations for Nursing Facilities (October 31, 2013) is intended to serve as an education resource for nursing facility members as they evaluate MCO contract proposals from each of the three health plans that the Virginia Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS) are working with under the Commonwealth Coordinated Care program - Virginia's Dual Demonstration.  Commonwealth Coordinated Care: VHCA Comparison of DMAS Approved MCO Nursing Facility Agreements (November 12, 2013) is intended to serve as an education resource for nursing facility members as they evaluate MCO contract proposals from each of the three health plans that the Virginia Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS) are working with under the Commonwealth Coordinated Care program - Virginia's Dual Demonstration.

DMAS announced this week that the Department has posted the Notice of Intent to Award (NOIA) announcing its intent to award contracts to Offerors for the Commonwealth Coordinated Care (Medicare-Medicaid Financial Alignment) Demonstration.  The following Offerors were selected for all five Demonstration regions:

VA Humana Health Plan, Inc.
VA Premier Health Plan, Inc.
HealthKeepers, Inc.

The NOIA was posted on the DMAS website and on the eVA procurement system.  Click here to view the notice.