Dual Demonstration Update: MCO to Meet with VHCA Committee

Following up on last week’s news related to outreach efforts by managed care organizations (MCOs) as part of their planning for possible participation in Virginia’s proposed Medicare/Medicaid payment alignment pilots (Dual Demonstration), this week we had a request from Virginia Premier, a health plan affiliated with Virginia Commonwealth University, to meet for purposes of sharing information and perspectives related to facility-based long term care services.

Members of VHCA’s Ad-hoc Managed Care Committee will meet with senior leadership of Virginia Premier in mid-October.  The meeting should provide a good opportunity for nursing facilities to hear more about the Dual Demonstration directly from MCO representatives and should also give members a chance to share critical information about the realities of care delivery to beneficiaries with both Medicare and Medicaid coverage.  To date, the lack of specific information from the Department of Medical Assistance Services (DMAS) and from the Centers for Medicare and Medicaid Services (CMS) about the Dual Demonstration has served to frustrate both the provider community and MCOs.

MCOs will be required to submit information about their networks to both DMAS and CMS in order to satisfy the network adequacy analysis as part of the MCO selection process.  The CMS timeline establishes February 21, 2013 as the deadline for MCOs to submit their networks to the Health Plan Management System (HPMS).  DMAS plans to make available by December 31 of this year the Requests for Applications (RFAs) for MCOs and would require MCOs to submit network information and composition to the Department sometime in the winter/early spring of 2013.  

Virginia is one of 26 states seeking CMS approval to implement a three-year pilot which would combine Medicare and Medicaid funding for dual eligible beneficiaries.  All health care services provided to these individuals would be coordinated through, and payment made by, MCOs in each of four designated geographic areas comprising the Demonstration.  Under the proposal, 164 of 267 Virginia Medicaid-participating nursing facilities (61.4%) are located in one of the four pilot areas.  Beneficiaries would be automatically enrolled effective January 1, 2014.