DMAS Holds Initial Dual Eligible Stakeholder Meetings

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On Wednesday, March 21st the Department of Medical Assistance Services (DMAS or the Department) held the first in a series of meetings intended to gain stakeholder involvement and support for its proposed plan to integrate care for Medicare-Medicaid enrollees or dual eligibles.  Two sessions were held on the 21st – a two-hour general information session followed by a meeting focused on issues related to nursing facilities and hospitals.

DMAS submitted a letter of intent in late 2011 to the Centers for Medicare and Medicaid Services (CMS) signaling its desire to pursue a capitated model that integrates Medicare and Medicaid funding and services under a contract with CMS and unnamed managed care entities.  In that letter, DMAS outlined its plan to implement the model in three geographic areas of the Commonwealth – Northern Virginia, Richmond/Charlottesville and Tidewater in December 2012.

Two key changes were announced during the March 21st meetings.  First, the Department now indicates that the capitated model for dual eligibles will be delayed with initial implementation occurring in January 2014.  Second, the geographic areas to be included in the demonstrations have been modified and expanded.  Instead of the three areas identified above, DMAS now indicates that four areas will be included in the demonstrations.  The areas announced are:

  • Central Virginia (42 localities)
  • Northern Virginia (11 localities)
  • Tidewater (13 localities)
  • Western/Charlottesville (14 localities)

These areas are defined by federal information processing standards codes (FIPS codes), standardized codes issued by the National Institute of Standards and Technology to ensure uniform identification of geographic entities through all federal government agencies.  The makeup of these areas was not disclosed in the meetings; however, DMAS supplied the information to VHCA in response to a request following the meeting.  We have prepared a table showing the demonstration regions along with a list of all nursing facilities included in the FY 2010 Medicaid cost report summary provided by DMAS indicating their status as to included or excluded from the dual eligible integrated care demonstrations.

The March 21st DMAS meetings were long on policy concepts from a 30,000 foot perspective and short on details and specifics.  Under the demonstrations, health plans (managed care entities) will receive a capitation rate that will reflect the integrated delivery of the full continuum of Medicare (Parts A, B and D) and Medicaid benefits.  DMAS plans to pursue passive enrollment of all dual eligible beneficiaries in the four demonstration areas with an opt-out provision during open enrollment and any time thereafter.  Several groups were identified as being excluded from the demonstrations including PACE participants and individuals enrolled in Hospice at the time of implementation. 

Information presented by DMAS staff identified the following impacts of the integrated care model on nursing facilities:

  • Streamline billing and support for providing person-centered care
  • Coordinators to help improve access to acute and primary services
  • Addressing the current three-day hospital stay Medicare requirement

Copies of the presentation materials from the March 21st meeting are now available on the VHCA website.  As soon as they are available, we will provide links to the documents.  The Department will be drafting its proposal to CMS and posting it for a 30-day public comment period which is anticipated to run from mid-April to mid-May.  DMAS intends to submit its proposal to CMS by May 31st with a second public comment period in the June/July timeframe.  VHCA has formed an ad-hoc committee to evaluate the proposal and to offer input to the Department.  We will keep members informed of any developments as DMAS moves through the proposal development and approval process.