Commonwealth Coordinated Care Update

The official start of the Commonwealth Coordinated Care Program (CCC) in the Tidewater Region of Virginia began on July 1st.  There are approximately 1,400 nursing facility residents now enrolled in the program. VHCA continues to work diligently with DMAS and the Medicare-Medicaid Plans (MMPs) to ensure that the roll-out of the program is as smooth as possible.  

On Monday, VHCA staff and members met with the Department of Medical Assistance Services (DMAS) and the MMPs to continue working through both outstanding and new issues related to the CCC implementation.  At the meeting, a number of issues were discussed.  The major takeaways from this week’s meeting are provided below:

  1. All three MMPs have assured VHCA they can process claims electronically.  This is critical to ensuring that nursing facilities are paid in a timely manner (within 14 days).  VHCA requests that if claims are not being paid in a timely manner that facilities contact the MMPs and VHCA immediately.  The MMP, DMAS and VHCA are watching the processing of claims closely and would like to be informed of issues VHCA members are having sooner rather than later. If issues do arise with claims processing, the MMPs have agreed to pay claims without delay.

  2. It has come to VHCA’s attention that many CCC’s enrollees are being assigned a primary care physician (PCP) that may not be their current one.  The primary reason for this is MMPs do not know the enrollee’s current PCP or the PCP may not be a part of the MMP’s provider network.  VHCA, the MMPs and DMAS are actively working to find a solution to this issue.  In the meantime, VHCA request that members send a list of their PCPs to the plans, so they can verify if the PCP is in or out of their network.  If they are not in-network, the MMPs will attempt to have them join.  If the resident’s current PCP is in network, the CCC enrollee may call the MMP and request that they be assigned to them.  If the PCP is out-of-network the enrollee is entitled to maintain their current PCP for a period of 180 days from enrollment.  In this situation, the PCP must be willing to enter into a single-case agreement with the MMPs.  VHCA anticipates that PCPs will not be the only downstream providers affected by this situation, so we urge you to ensure that pharmacy, therapy and lab providers are aware of this potential issue.

  3. There have been many questions about the frequency of the post payment review process.  During discussion this week, the MMP assured VHCA that post payment reviews will be primarily focused on Medicare services and more limited on Medicaid.  We are working to have more specifics around this issue put in writing, so VHCA can provide the details to members.

  4. There continues to be many questions around the procedures and authorization of skilled nursing services beyond the 100-day benefit period.  DMAS has sent a list of possible scenarios to CMS for clarification. 

It is not a surprise as we enter the live phase of the demonstration project that additional issues and questions are being brought forward by all parties.  With this in mind, VHCA has created an issue log on the VHCA website where members can submit questions or issues related to the CCC.  The log sheet goes directly to staff, so you should receive a quick response.  In addition, as provided in an earlier edition of the CareConnection, DMAS has created one-page quick reference guides for each of the three MMPs: 

The guides include important contact information and resources for claims submission and authorizations.  This information is also available on the DMAS website.  If you have any questions on the CCC, please contact Steve Ford at 804.212.1695 or via email at steve.ford@vhca.org.