DMAS Submits Modified Dual Eligible Proposal to CMS

On May 31st, the Department of Medical Assistance Services (DMAS) submitted its proposal to the Centers for Medicare and Medicaid Services (CMS) to implement a Dual Eligible Integration Demonstration in Virginia.  Based upon communications between VHCA’s Ad-hoc Medicaid Managed Care Committee and DMAS, the Department incorporated two key changes requested by VHCA in their final proposal.  The proposal now contains a provision that managed care organizations (MCOs) must enter into provider contract with any willing nursing facility that has a Medicaid provider agreement in place.  Additionally, under the Demonstration, MCOs must pay no less than the equivalent fee for service Medicaid rate payment as determined by DMAS.

Given the significance of these two concessions by DMAS, earlier this week members of the Ad-hoc Medicaid Managed Care Committee indicated their support for a letter of qualified support from VHCA to DMAS.  DMAS had requested that all stakeholders provide letters of support to accompany the Demonstration proposal submitted to CMS.  VHCA’s letter lends support for the overall goals of the Demonstration but also highlights a number of remaining concerns for nursing facilities identified by the committee.

As previously reported,  the goals of the Demonstration are to reduce cost shifting between providers and payors; create a seamless, integrated service delivery system; align Medicare and Medicaid rules; improve accountability; produce savings for both the states and the Federal governments; and share Federal savings with the states in order to provide care coordination and other supplementary benefits.   Under the plan, contracted MCOs will be accountable for the care delivered to enrollees, including care coordination efforts.  MCO performance will be measured, and payment will be tied to measured quality goals.  Care will be delivered using integrated care teams and care management services that are based on the needs and goals of enrollees.  MCOs may offer supplemental/enhanced benefits that exceed those currently provided in either Medicare or Medicaid, in order to encourage and retain enrollment, promote health, and provide services in the most appropriate and efficient settings.

Members are encouraged to review all documents maintained in the library which was established to house information related to the evaluation of the Dual Eligible Financial Alignment Demonstration and documents the efforts of VHCA’s Ad-Hoc Committee on Medicaid Managed Care.  The resource library is located here and requires VHCA member access to view the documents.