Commonwealth Coordinated Care Update

Earlier this week, a second Commonwealth Coordinated Care (CCC) town hall meeting was held in Fredericksburg.  These meetings are intended to provide information about Virginia’s dual eligible financial alignment demonstration to both beneficiaries and providers, including nursing facilities.  Representatives from the Department of Medical Assistances Services (DMAS) report that approximately 1,500 individuals have initiated the process to enroll in the CCC voluntarily.  As of March 19, DMAS reported that only 14 dual eligible beneficiaries residing in nursing facilities in the Tidewater and Central/Richmond CCC regions had initiated voluntary enrollment efforts.

Members of VHCA’s Ad hoc Managed Care Committee continue to meet with the three contracted health plans (Medicare-Medicaid Plans or MMPs) and DMAS to work toward the adoption of common processes and requirements around a range of operational and financial issues under the CCC.  These issues include:Service authorizations and reauthorizations

  • Care coordination and implications for care planning
  • Quality measurement and reporting
  • Care transitions
  • Claims testing
  • Handling of Medicaid patient pay in connection with claims submission
  • Payment for Medicare bad debt
  • Emergency payment provisions

Over the next month, we intend to share specific information with our members reporting the outcome of these meetings and discussions.  We encourage member facilities to monitor these discussions as they evaluate the decision to execute provider agreements with one or more MMPs.

We remind our members that an issue identified recently that may have significant implications for dual eligible resident populations in nursing facilities focuses on a provision in the three-way contract between the Centers for Medicare and Medicaid Services (CMS), DMAS and MMPs that stipulates that beneficiaries with other insurance coverage are not eligible to participate in the CCC program.  It is not uncommon for nursing facility residents to have Medicare supplemental insurance policies.  DMAS has indicated that traditional Medigap and Tricare policies indeed meet these criteria.  One primary concern related to this provision is that DMAS and its enrollment broker MAXIMUS do not maintain records that identify which dual eligible beneficiaries have supplemental insurance in effect.  Facilities are encouraged to identify residents with this type of coverage and communicate and clarify the CCC participation restriction to residents, resident’s families or their representatives with this coverage.

Earlier this month, MAXIMUS mailed letters to all identified dual eligible beneficiaries announcing the new managed care program.  Unfortunately, the beneficiary letters do not provide significant guidance to beneficiaries about their option to opt-out of the CCC and to remain covered under both traditional Medicare and Medicaid fee-for-service programs.  As patients and residents and their families or representatives seek additional information about the CCC, it is important that they be made aware of this option.  Eligible beneficiaries may opt-out of the CCC by calling MAXIMUS at 855.889.5243.

During the month of May, Maximus is scheduled to begin the automatic (passive) enrollment process for all identified dual eligible beneficiaries in the Tidewater region.  Coverage and payment for services provided to those CCC Tidewater enrollees will begin July 1, 2014.