Please Provide Input to DMAS by June 16th on Proposed Managed LTSS Program

The Department of Medical Assistance Services (DMAS)  is soliciting comments from stakeholders regarding their plans for managed LTSS by 5:00 pm of June 16, 2015 (this is a change from the original deadline of June 1.)  VHCA will be commenting on behalf of the membership, but we also encourage members to provide comments as well.  VHCA remains concerned with the implementation issues related to the CCC program and we continue to work with DMAS and the MMPs to correct these issues.  The primary issues have been an inability to properly pay claims, a lack of care coordination for patients, and an increased administrative burden on facility staff.  These types of issues should be resolved and evaluated prior to expanding the Medicaid managed-care program for nursing facility residents statewide.

To provide public comment, please follow the instructions on page 4 and do so by 5:00 pm on June 16.

As you know, the Department of Medical Assistance Services (DMAS) has proposed a two-step initiative (as reported in the May 14 CCC Update) to implement a managed care model on the remaining fee-for-service (FFS) population receiving long term services and supports (LTSS), including nursing facility residents and services.  Specifically, in the first phase, DMAS intends to make participation with one of the Commonwealth Coordinated Care (CCC) plans mandatory for the Medicaid benefits (Medicare benefits could still be FFS if the beneficiary so chooses).  This phase would impact up to approximately 35,000 dually eligible individuals who are not currently enrolled in the CCC program. In terms of the nursing facility population, the most recent estimates indicate just under 5,000 residents could be impacted by this phase.  DMAS has announced a target implementation date of July 1, 2016 for this first phase of the plan.

In the second phase, DMAS would extend this Medicaid only model to the non-dual, long term care population within the CCC demonstration regions, as well as both the dual and non-dual populations in the areas of the state not subject to CCC.  Phase two is still largely undefined; it appears that DMAS intends to procure health plan participation and it is possible linkages to Medicare managed care offerings (Medicare Advantage, Duals Special Needs Plans, etc.) may be preferred or required.  The most recent statements from DMAS indicate a target implementation date in mid-2017.