CCC Update: Coverage for Auto-Enrollees begins September 1 in Central Virginia

Beginning Monday, September 1, coverage becomes effective under the Commonwealth Coordinated Care (CCC) program for approximately 2,200 nursing facility residents (DMAS estimate as of 8/11) in the Central Virginia Demonstration Region.  This marks the second of five regional expansions of the auto-enrolled population (Tidewater went live in July), and represents the largest expected enrollment among the five demonstration regions.  As previously described, auto-enrollment, officially termed “Passive” enrollment, occurs when a CCC-eligible individual has not already opted-out of the program.  These individuals received enrollment letters in July (60 day notice) and again in August (30 day notice).  CCC participants may opt-out of the program at any time (with CCC coverage remaining through the end of the month during which the opt-out occurs), and CCC-eligible individuals not enrolled can opt-in to the program at any time (with coverage effective dates depending on the time of the month in which they opt-in).

Two additional regions, Charlottesville/Western and Roanoke, are slated for effective coverage of auto-enrolled participants for October 1.  Northern Virginia is slated for effective coverage of auto-enrolled participants on November 1.  

It is important to note that some localities in these demonstration regions may not be fully operational under CCC due to Medicare/Medicaid Plan (MMP) network adequacy concerns.  While locality status can change as network adequacy is achieved, currently, the following localities are affected by network adequacy concerns:

  • Central Virginia Region – Mecklenburg County has no CCC eligibility (neither voluntary nor passive) as no MMPs have achieved network adequacy; the rest of the region is eligible for passive enrollment
  • Charlottesville/Western Region – Harrisonburg and Staunton are only eligible for voluntary enrollment due to only one MMP having network adequacy there; the rest of the region is eligible for passive enrollment
  • Roanoke – Wythe and Henry Counties, and the City of Martinsville are eligible only for voluntary enrollment; the rest of the region is eligible for passive enrollment
  • Northern VA – only Culpeper and Prince William Counties, and the City of Manassas are currently eligible for passive (auto) enrollment; the rest of the region is only eligible for voluntary enrollment

As the program continues to expand, we strongly encourage you to share your ancillary provider lists with the MMPs and to encourage those providers to participate within the MMP networks.  This will help to minimize the potential for disruption in caregivers for your residents to the extent they join CCC either voluntarily or under passive enrollment.