CCC Updates

Eligibility Information:  The Department of Medical Assistance Services (DMAS) has made available a report, called the 270/271, that allows for batch queries of eligibility status, including enrollment status with Commonwealth Coordinated Care (CCC).  However, facilities and their IT staff/vendors have had difficulty accessing the data in a useable format, with staff generally reverting to the existing Medi-Call/ARS system, with limited batch query capability.  

In light of the difficulties our members have had in accessing and utilizing the DMAS eligibility information batch file, DMAS has agreed, as an interim solution, to provide a monthly enrollment file with CCC enrollment status to nursing facilities who request the information.  The file agreed upon will contain enrollment status as of the first of the month, and will only be run monthly.  Since enrollment and disenrollment under CCC is monthly, this file should be a good proxy for eligibility and enrollment in CCC for the given month.  

As communicated last week, in order to receive the enrollment information as described above, DMAS has asked that you provide one contact email for your facility(ies) and your NPI(s).  DMAS has asked VHCA to compile this information, so please send it to steve.ford@vhca.org.  While the initial cutoff for this contact information has passed, DMAS is willing to update the list for subsequent file submissions.  For those facilities that have already responded with contact information, it is our understanding that the initial file should be coming your way in the next few days.  VHCA is not a party to the file transmission due to HIPAA privacy concerns, so if you have difficulty, please let Steve Ford (e-mail above) know.

DMAS has indicated that this is only an interim solution, so we continue to encourage you and your IT staff/vendors to work towards accessing and utilizing the 270/271 eligibility file as the current long term solution to your need for eligibility status.

Locality Participation Status:  VHCA remains active in dealing with implementation issues for the CCC program.  To that end, this article is intended to provide members updates on the status of the rollout and information about resources available to ease the transition to CCC.  Next Thursday, September 18th, as part of the VHCA 2014 Convention and Trade Show, representatives from all three Medicare/Medicaid Plans (MMPs), nursing facility industry leaders, and representatives from the Department of Medical Assistance Services (DMAS) will participate in a session titled Commonwealth Coordinated Care Update: Status of the Rollout, Lessons Learned, Best Practices and Issues Outstanding.  Information on the convention, including registration information can be found here.  We expect this session to be very informative for the membership, particularly those members in the upcoming expansion regions for CCC.

As far as the status of the roll-out, the Central Virginia demonstration region began active coverage for individuals automatically enrolled on September 1st.  All localities in the Central region, except for Mecklenburg County, are now fully active in CCC.

The next regions scheduled to go live under automatic enrollment are Charlottesville/Western and Roanoke.  Coverage for those automatically enrolled in these regions will begin on October 1st.  In Charlottesville/Western, all localities are eligible for auto-enrollment except for the cities of Staunton and Harrisonburg (those two localities are open for opt-in enrollment in CCC).  For the Roanoke region, Wythe and Henry County, and the City of Martinsville are currently only open for opt-in enrollment (no auto-enrollment at this time), with the rest of the region eligible for auto-enrollment.

On November 1st, localities in the Northern Virginia region will go live for coverage under auto-enrollment; however, currently this only applies to eligible individuals associated in the localities of Culpeper or Prince William County, or the City of Manassas.  All other localities in the Northern region are eligible for opt-in enrollment only at the current time.  

Eligibility of a locality for auto-enrollment depends on at least two MMPs obtaining network adequacy for that locality; as the MMPs continue to expand their networks, auto-enrollment status will change.  However, 60 day notice to an auto-enrolled individual is always required prior to effective coverage.  The complete status of plan coverage by locality can be found here.


Ancillary Providers:  VHCA continues to encourage you to provide ancillary provider lists to the MMPs covering your residents under CCC.  As previously reported in this publication, a significant issue that has emerged as Tidewater went live under passive enrollment in the Commonwealth Coordinated Care (CCC) program is the issue of ancillary providers that come into the nursing facilities to provide care.  These providers range from the physician group providing routine services to your residents, to the pharmacy that fills prescriptions, to the lab tech who draws samples for various tests.  It is in your interest to encourage these ancillary providers, with whom you already contract and credential, to consider becoming part of the network for the MMPs serving your residents.  While it does not guarantee that your residents will continue to use these providers under CCC, those providers being in network provides the best chance for such an outcome.  It is important to understand that MMPs will attempt to utilize networked providers first.  While the CCC program contains a continuity of care protection for current nursing facility residents (residents who are already in the facility when they enroll in CCC), this is only temporary (180 days for physician coverage, for example) and does not apply to new admits who are already enrolled in CCC.  To restate, it is in your interest for the providers with whom you already have relationships to participate with the MMPs covering your residents (current and future).  By providing these lists to the MMPs, the MMPs can reach out in their network development efforts and facilitate the network participation discussion.

CCC Issue Log:  As the Commonwealth Coordinated Care (CCC) program continues its expansion across the five demonstration regions, residents and nursing facility personnel in those regions begin dealing with an array of issues associated with the new program.  Many issues have been identified, as have approaches to minimize their impact.  In order to facilitate the discussion of solutions with the Department of Medical Assistance Services (DMAS) to the array of issues with CCC, it is imperative that VHCA be made aware of the on-the-ground issues you experience with CCC.  To this end, VHCA developed the CCC Issue Log, which is available publically (no member log-in required) on our website, www.vhca.org, under “News & Events” on the right hand side of the homepage.  

Please consider sharing this link with your frontline staff (both indirect and direct care staff) for input on all aspects of the CCC program.