Commonwealth Coordinated Care Update

Beginning this week, individuals with full Medicare and Medicaid benefits in the Tidewater Region of the Commonwealth Coordinated Care (CCC) program will receive letters announcing that effective July 1, 2014 they will be assigned to one of three Medicare-Medicaid Plans (MMPs). The letter from the Virginia Department of Medical Assistance Services (DMAS) indicates that their traditional coverage provided through the Medicare and Medicaid programs will cease as of that date unless they choose to opt-out of the CCC.  

The decision to opt-out of the CCC lies with the beneficiary or their authorized representative.  We have communicated to DMAS that nursing facilities often assist residents in an informal capacity when they have no family or other legally recognized individual to act on their behalf.  Additionally, there are times when individuals within provider organizations are appointed as guardians to legally act on behalf of residents who are no longer able to make decisions due to cognitive deficiencies.  DMAS has committed to working with the Centers for Medicare and Medicaid Services (CMS) to develop practical guidance for providers as they face questions related to CCC participation.

Meetings between MMP, DMAS and nursing facility representatives are continuing.  These meetings are intended to provide an opportunity for the three MMPs to identify common approaches to a range of operational issues in their relationships with nursing facilities.  Earlier this week, agreement was reached on authorization and reauthorization requirements related to nursing facility admissions for both skilled and long stay services.  We anticipate finalization of the authorization and reauthorization requirements next week and plan to share this important information with all VHCA members at that time.  Discussions are ongoing with respect to care coordination related issues.  As reported in last week’s CareConnection, VHCA members are encouraged to participate in claims testing with all three MMPs.

Members are reminded that the product and outcome of the workgroup meetings discussed above will be reflected in modifications to all three MMP Provider Manuals.  Additionally, DMAS has indicated that this same information will be communicated to all providers and MMPs via an upcoming Medicaid Memo.