Commonwealth Coordinated Care (CCC) Update

The Office of the State Long Term Care Ombudsman can be a resource for issues with CCC.  As most of you are aware, when the Department of Medical Assistance Services (DMAS) designed CCC, it included a role for the Ombudsman program with a mission of advocating on behalf of older persons receiving long term care services, including those residing in nursing facilities.  Specifically, the program, which resides in the Department for Aging and Rehabilitative Services (DARS), is empowered to provide problem-solving and advocacy services to assist CCC enrollees of any age with issues such as:

  • Continuity of services
  • Access to service and support
  • Services coverage under CCC
  • Timeliness of services and care
  • Grievances and appeals
  • Enrollment and disenrollment

In addition, the Ombudsman program is tasked to provide information about CCC trends, issues and make recommendations for improvement.

The Ombudsman program reports quarterly to DMAS and the Centers for Medicare and Medicaid Services (CMS) relative to its mission.  VHCA has initiated a conversation with DMAS and DARS regarding access to the Ombudsman reports, including consideration that DMAS co-mingle this information in its newly-required quarterly implementation reports mandated by the 2015 Appropriations Act.

While we do not have any direct experience regarding the effectiveness of the efforts undertaken to advocate on behalf of beneficiaries by the Ombudsman (although some VHCA members may), this could be a valuable tool for both issue resolution and, at a more basic level, issue identification back to DMAS and CMS regarding concerns with CCC, primarily in the area of beneficiary experience and access.  As such, we would encourage you to consider contacting the Ombudsman both for direct assistance with navigating the system, but also to document the experiences in the field in the areas under the purview of the Ombudsman so that recommendations can be developed.

Beneficiaries and their advocates, and providers, can contact the CCC Advocate Manager, Susan Johnson at the DARS Voice Toll-free number at the Central Office – 800-552-3402, or directly at 804-662-7162 (or e-mail Susan.Johnson@DARS.virginia.gov).  In the Southeastern Region (Tidewater and parts of the Central VA region in CCC) and Central Virginia (Richmond Metro), the Ombudsman has regional advocates that can assist:

DMAS is reaching out to CCC-eligibles who have opted-out of the program.  DMAS has announced its intention to send letters to CCC-eligible beneficiaries who have opted-out of CCC encouraging them to reconsider their decision and opt-in to the program.  These letters, according to DMAS, will be issued at the 12-month anniversary of the beneficiaries’ decision to opt-out of CCC; practically speaking, this means that the letters would primarily hit your residents who opted out of the program around 10-12 months after the region began the passive enrollment process (for example, Tidewater would see an uptick in these letters in May/June, since the region went live for passive enrollment last July).  As you know, most of the opt-outs occurred once the beneficiary received notice that they would be enrolled automatically (60 days prior to coverage).

DMAS staff has reiterated the previous policy that they are not automatically enrolling these folks who previously opted-out; they are simply encouraging eligibles to consider opting-in (see attached letter)   We have also inquired about implications of a decision to opt-in to CCC as that relates to Part C (Medicare Advantage) and Part D coverage choices since the open enrollment periods under Medicare have ended.  We will follow-up with more information as it is received from DMAS.