Commonwealth Coordinated Care Program Update

As you have seen in the CareConnection in the last several months, the Commonwealth Coordinated Care (CCC) continues on its path to roll out across the five demonstration areas, the most recent milestone being the beginning of coverage in the Tidewater area under “passive” enrollment.  Passive enrollment means auto-enrollment of individuals eligible for the CCC program who have not explicitly opted-out, resulting in dual eligible CCC participation at volumes far exceeding what had previously been experienced through the recipient “opt-in” phase.  

Auto-enrollment letters have gone out to eligible recipients in the Central/Richmond region, for an effective coverage date of September 1.  Auto-enrollment letters are scheduled to go out to recipients in the Roanoke and Western/Charlottesville regions in August for coverage effective in October.  Rounding out the five demonstration regions, letters for auto-enrollment in Northern Virginia are now scheduled (it was announced last week that Northern Virginia was delayed one month) to go to recipients in September for coverage effective in November.

As the program rolls out, VHCA remains engaged with DMAS and the three Medicare/Medicaid Plans (MMPs) on implementation issues.  To that end, the VHCA Managed Care Ad Hoc Workgroup will be meeting with DMAS and the MMPs again on Monday, July 14th to discuss the list of unresolved questions/issues regarding CCC implementation.  Main issues remain around:

  • claims submission / processing / payment
  • service authorization / level of service
  • physician participation / willingness to see nursing facility residents
  • potential plan of care conflicts between nursing facility care teams and MMP care coordinators
  • post payment review procedures
  • and many others

CCC Issue Log Now Available Online

Please keep VHCA up to date on the Commonwealth Coordinated Care (CCC) issues you are experiencing so we can help!  Last week, we provided a link to a word document to capture CCC issues out in the field.  This log is now available for completion online – just fill it out and click submit, and let us assist you in finding a solution from DMAS and the MMPs.

You can access the form here or, simply go to the VHCA homepage and look under “News & Events”.

REMINDER: July 16th CCC Training Opportunity

The Department of Medical Assistance Services (DMAS) recently announced a training opportunity on the Commonwealth Coordinated Care (CCC).  DMAS is partnering with the Center for Health Care Strategies to offer half-day workshops that will give providers additional information about the new CCC program that blends Medicare and Medicaid services and benefits for individuals.  Workshop attendees will hear a national update on this initiative to align Medicare and Medicaid services across the country, a state update on CCC implementation, presentations from the three Medicare-Medicaid Plans (MMPs) providing care under CCC, and information about beneficiary rights.  Providers can expect to learn more about processes for authorizations, billing, and care management through the MMPs.  Please click here for the workshop agenda.
The morning workshop is geared towards nursing facility and personal care providers, and the afternoon session will focus on Service Facilitators.  Space is limited, so please RSVP your attendance as soon as possible to the CCC team.