Dual Demonstration Update

During a recent meeting with representatives of managed care organizations, staff of the Department of Medical Assistance Services (DMAS) shared some news and their updated regional implementation timing expectations with respect to Virginia’s proposed Medicare/Medicaid Financial Alignment Demonstration (Dual Demonstration).  

We have learned that DMAS anticipates that a Memorandum of Understanding between the agency and the Centers for Medicare and Medicaid Services (CMS) will be signed in April.  Shortly thereafter, DMAS will likely issue a Request for Application (RFA) to MCOs.  The RFA has been drafted and is now being reviewed by the Attorney General’s office.  DMAS is expected to require MCOs to respond within 6-8 weeks upon receipt of the RFA.

Late last week, VHCA staff spoke with Karen Kimsey at DMAS.  Ms. Kimsey serves as Director of Policy for the agency and plays a key role in developing and implementing the Dual Demonstration.  Since VHCA has been repeatedly assured by DMAS leadership that long term care providers will have significant input into the RFA process, we questioned her about that commitment given the news that the RFA was, in fact, already drafted and now in legal review.   Ms. Kimsey explained that the RFA was drafted to be general in scope and that it does incorporate recommendations and addresses concerns previously communicated by VHCA to DMAS.  She further elaborated that VHCA and its members will have ample additional opportunities to help shape the Dual Demonstration once DMAS begins the process of drafting contracts between the agency and MCOs.

Ms. Kimsey will meet with VHCA’s Ad-Hoc Managed Care Committee next week to discuss the draft RFA, the process for developing contacts between DMAS and MCOs and to review and discuss a series of financial and operational issues identified by the committee.

With respect to timing for implementing the Dual Demonstration, the following targets were shared with MCOs who attended last week’s DMAS meeting:

  • January and February 2014 – voluntary enrollment for Tidewater and Central Virginia regions
  • March 2014 – passive enrollment for Tidewater and Central Virginia regions
  • April 1, 2014 – Tidewater and Central Virginia regions go live
  • June and July 2014 – voluntary enrollment for remaining regions (Charlottesville/Western, Northern Virginia and Roanoke)
  • August 2014 – passive enrollment for remaining regions (Charlottesville/Western, Northern Virginia and Roanoke)
  • September 1, 2014 - Charlottesville/Western, Northern Virginia and Roanoke regions go live

Meeting attendees reported that they were less than 100% confident about the timing expectations for the Roanoke region.  This region was initially excluded from the DMAS Dual Demonstration proposal and was discussed in terms of a Phase II option.  Subsequently, DMAS has indicated that the scope of the Dual Demonstration has been expanded to include the Roanoke region as a fifth region.

Member facilities report that they are continuing to receive communications from health plans related to the proposed Dual Demonstration.  We encourage facilities to carefully evaluate requests to sign any document or contract beyond a non-binding letter of intent with MCOs.  At this point in time, sufficient information on which to form the basis for binding legal contracts between providers and health plans as it relates to the Dual Demonstration simply does not exist.

VHCA will provide an update following next week’s meeting of the Ad-Hoc Managed Care Committee.