Sept 11 2014 CCC Map

CCC Updates: Uniformity for Claims and DMAS Signals Intent to Extend the CCC

Published in September 10, 2015 Issue

MMPs Will Be Applying More Uniformity to CCC Claims:  The three Medicare/Medicaid Plans (MMPs) are collectively working on guidance to nursing facility providers to achieve more uniformity and clarity on billing under the CCC program.  There have been several billing issues primarily since the switch to RUGs-based billing back in November.  VHCA has been working with the Department of Medical Assistance Services (DMAS) and the MMPs for the past several months on various claims processing concerns, most recently through the formation of a claims processing workgroup involving VHCA members.

Sept 11 2014 CCC Map

DMAS Releases First Quarterly Report on CCC

Published in September 3, 2015 Issue

The Virginia Department of Medical Assistance Services (DMAS) recently published its first quarterly report on the Commonwealth Coordinated Care (CCC) program.  The report was required under new language passed during the 2015 General Assembly Session.  We have posted the full report on the VHCA CCC webpage

UPDATED CCC MAP

CCC Update: CMS Announces Optional Two-Year Extension to the Demonstration

Published in July 24, 2015 Issue

On July 16, the Centers for Medicare and Medicaid Services (CMS) issued a memo to states operating, or in the process of implementing, a Financial Alignment Demonstration, known commonly as a Duals Demonstration or in Virginia, the Commonwealth Coordinated Care (CCC) program.  This CMS memo offered assistance to “interested states to extend the scheduled end dates for each demonstration by two years.”  To request such an extension, states are required to submit a letter of intent by September 1.  While the Virginia Health Care Association (VHCA) has not heard any explicit decision by Virginia’s Department of Medical Assistance Services (DMAS) in regards to requesting an extension for CCC, we suspected that DMAS was involved in these discussions, as DMAS staff has alluded to the possibility of extending the timeframe for CCC in various recent discussions on the future of managed long term care.

UPDATED CCC MAP

Patient Pay Recoupment Summary Document Updated

Published in July 9, 2015 Issue

In the June 19th CareConnection, we alerted you that the three MMPs were beginning the recoupment of overpayments that accumulated due to their initial inability to properly apply patient pay amounts to their payment rates.  Included in that article was a link to a summary document created by the three MMPs.  In an effort to ensure you have the most recent information, that document has been updated by the three MMPs.

UPDATED CCC MAP

VHCA Calls for CCC Improvements Prior to Any Expansion of Managed Medicaid LTC

Published in June 25, 2015 Issue

The Virginia Health Care Associations (VHCA) cautions that expanding the managed Medicaid long term services and supports (MLTSS) program, including nursing facility services, should not proceed prior to the successful resolution of the many issues within the existing Commonwealth Coordinated Care (CCC) program, the association advised in comments submitted to the Department of Medical Assistance Services (DMAS) on June 16. 

REMINDER: Deadline Extended for Public Input Until June 16th for Stakeholder Input on Proposed Managed LTSS Program

Published in June 12, 2015 Issue

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.

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

Published in June 4, 2015 Issue

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.

CMS Issues Proposed Rule Addressing Managed Care Regulations

Published in May 28, 2015 Issue

This week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule updating the way states should implement managed care programs within the Medicaid program, including those covering long term care services and supports (LTSS).  As this rule was just released, VHCA staff is still reviewing the proposed changes in terms of their relevance under the Commonwealth Coordinated Care (CCC) program and any future iteration of managed LTSS (MLTSS) in Virginia.  Two weeks ago in this publication, we discussed the plans announced by the Department of Medical Assistance Services (DMAS) regarding changes to CCC and a future statewide Medicaid MLTSS program, including nursing facility services (see the CCC update from May 14).  As the discussions around these future plans evolve, the rule issued by CMS will certainly need to be considered in that design.

CMS Issues Memo Outlining Concern with SNF Practices Related to Disenrollment from Medicare Advantage and Dual Demonstration Plans

Published in May 28, 2015 Issue

In a memo dated May 26th, the Centers for Medicare and Medicaid Services (CMS) asserts that they continue “to see an unacceptable practice of LTC facilities disenrolling beneficiaries from Medicare advantage prescription drug plans (MAPDs) and enrolling them into stand-alone drug plans (PDPs) without the beneficiary’s or the representative’s knowledge and/or complete understanding.” They go on the state that “Similarly unacceptable practices have been seen among LTC facilities serving Medicare-Medicaid (dually eligible) enrollees eligible to join a Medicare-Medicaid plan (MMP) as part of a demonstration under the Financial Alignment Initiative”, which would include the Commonwealth Coordinated Care (CCC) program in Virginia. 

Deadline Extended for Public Input Until June 16th: DMAS Seeking Stakeholder Input on Proposed Managed LTSS Program

Published in May 28, 2015 Issue

As you know, the Department of Medical Assistance Services (DMAS) has proposed a two-step initiative 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.

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update

Published in May 14, 2015 Issue

May Enrollment Figures.  As reported previously, the Department of Medical Assistance Services (DMAS) has passively enrolled dual eligibles in Wythe County, Staunton, and the Northern Virginia localities of Loudoun County, Arlington County, Alexandria, and Falls Church for effective coverage July 1, 2015.  Additionally, it appears that a substantial number of nursing facility dual eligibles were determined eligible for the CCC program across the demonstration regions who had previously not been eligible for the program (at least as a nursing facility resident).  It is not yet clear as to why this increase in the eligible population occurred (particularly outside of Northern Virginia) – we have inquired with DMAS as to their understanding of what caused the increase, but we have not yet received their response.

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update – Expansion Edition

Published in April 30, 2015 Issue

As we have reported in previous CareConnection articles, the Department of Medical Assistance Services (DMAS) recently approved several localities previously only subject to voluntary enrollment under CCC to move to passive, or automatic, enrollment of recipients eligible for the program.  This move was predicated upon the approval of network adequacy of a second Medicare/Medicaid Plan (MMP) in each of the localities affected.  The specific localities affected, by region, are:

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update

Published in April 16, 2015 Issue

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:

Sept 11 2014 CCC Map

The Department of Medical Assistance Services (DMAS) Clarifies Credit Balance Audit Issues

Published in April 2, 2015 Issue

VHCA members had voiced concern over the normal audit process administered on behalf of DMAS by Myers & Stauffer as it relates to credit balances caused primarily by patient pay, and other claims processing issues with the three Medicare/Medicaid Plans (MMPs) under the Commonwealth Coordinated Care (CCC) program.  Obviously, while the MMPs continue to sort out their processing issues, a recoupment by DMAS of credit balances would only serve to complicate the books further.

Commonwealth Coordinated Care (CCC) Auto-Enrollment in Additional Localities Delayed One Month

Published in April 2, 2015 Issue

In the March 20th CareConnection, we reported that six localities (four in Northern Virginia and two in other areas) were transitioning from opt-in only under CCC to passive, or automatic, enrollment.  Eligible individuals were expected to be receiving their first letter indicating enrollment in the program this week, with coverage effective under CCC on June 1st.

DMAS Announces Expansion of Auto-Enrollment under CCC; Includes Four Additional Localities in Northern Virginia

Published in March 20, 2015 Issue

DMAS has announced that several localities where CCC-eligible beneficiaries are currently only allowed to opt-in to CCC are moving to passive, or automatic, enrollment status effective for coverage June 1, 2015.  You may recall that in order for an eligible beneficiary to be auto-enrolled in CCC, there must be more than one MMP with adequate network coverage in that beneficiary’s locality (based on the DSS that maintains the case file).   If an additional MMP achieves network adequacy in that locality, the eligible beneficiary now has choice of MMP, and the locality switches to automatic enrollment status under CCC.  It remains the case that a beneficiary is allowed to opt-out of the program at any time.

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update

Published in March 5, 2015 Issue

The Virginia Health Care Association (VHCA) continues to monitor the claims processing issues experienced with each of the CCC Medicare/Medicaid Plans (MMPs).  In discussions with the Department of Medical Assistance Services (DMAS) and the MMPs this week, the MMPs have asserted that the claims that had been affected by systematic issues have either processed through to payment or are in process and should produce payment in the next week to week and a half.  As such, we have increased scheduled discussions with the MMPs and DMAS, and need your feedback regarding the receivables you expect and the payments you receive relative to the backlog of claims.  As always, feedback on this issue should be sent to Steve Ford at steve.ford@vhca.org.  It is important that we hear whether or not you are experiencing any relief regarding outstanding claims, the extent of that payment, etc., as we have already begun some discussion of other interim measures to ensure the financial viability of our members during this “fix” period.

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update

Published in February 19, 2015 Issue

Anthem Data Breach Information

Anthem has provided the following information (and attached FAQ) regarding services in response to the much-reported data breach of their systems.  You may want to consider providing this information to CCC residents/patients on the Anthem HealthKeepers MMP, although they should also be receiving this information directly from Anthem:

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update

Published in February 12, 2015 Issue

Claims Processing Concerns

Over the past few weeks, significant claims processing issues among the three Medicare/Medicaid Plans (MMPs) have come to light, with substantial receivables adding up for nursing facilities.  We requested accounts receivables information from the field and 103 facilities responded, representing nearly $12.2 million in accounts receivable outstanding through 12/31 for CCC Medicaid residents alone.  We had alerted the Department of Medical Assistance Services (DMAS), who was unaware of the issues as most of the claims had rejected and where therefore not yet “in process” to show up on reports from the MMPs to DMAS.  In response, DMAS initiated meetings with the MMPs to work through the issues at hand.

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Update

Published in January 28, 2015 Issue

VHCA was asked to present a status update on the CCC program from the nursing facility perspective to the Health and Human Resources Subcommittee of the House Appropriations Committee this past Tuesday (January 27th).  Other perspectives were provided at that meeting as well, including DMAS, the Association of Health Plans, each of the three MMPs, the Hospital Association, and Home Care and Hospice Association.  The materials from the meeting (VHCA’s and the others) can be accessed here (scroll to the January 26th meeting - the meeting was on the 27th, but the heading mistakenly says January 26th).

Sept 11 2014 CCC Map

Commonwealth Coordinated Care (CCC) Updates

Published in January 15, 2015 Issue

Anthem HealthKeepers Willing to Contract with Lab Providers other than LabCorp.  As you know, one of the ancillary provider issues that emerged under CCC was Anthem’s exclusive use of LabCorp for lab services.  This caused significant concern among nursing facilities as is was not clear that existing lab services providers would be reimbursed for CCC residents, nor was it entirely clear how efficiently LabCorp could work given their previous business practice of not serving nursing facilities in terms of  phlebotomy.

UPDATED CCC MAP

Commonwealth Coordinated Care (CCC) Update

Published in December 12, 2014 Issue

Things have not been moving as quickly as we would like in regards to CCC issue resolution, despite the Virginia Health Care Association’s (VHCA) efforts.   However, we did want to provide an update on where things stand, as we have received some responses to various issues:

Sept 11 2014 CCC Map

CCC Update

Published in November 20, 2014 Issue

VHCA continues to pursue resolution to multiple issues associated with the Commonwealth Coordinated Care (CCC) program.  These issues include Part A authorizations, problematic primary care physician assignment, and many other issues of concern.  While progress on resolution to these issues has been admittedly slow, despite the collective efforts of VHCA membership and staff, we continue to press DMAS and the MMPs on these known and emerging concerns.  To that end, we encourage you to provide examples of the issues you are facing (with personal health information removed, of course) through the CCC Issue Log or other means.  Concrete examples provide staff empirical data, as opposed to what has often previously been theoretical, to enhance DMAS’ understanding of the implementation concerns.  We appreciate your support of this endeavor.

Sept 11 2014 CCC Map

CCC Update: Roster Billing for Vaccines

Published in November 14, 2014 Issue

A question from the field arose over roster billing for vaccines (pneumonia and influenza, primarily) in the Commonwealth Coordinated Care (CCC) Program.  Earlier this week, the Department of Medical Assistance Services (DMAS) provided the following information for each of the three CCC Plans:

Sept 11 2014 CCC Map

CCC Update

Published in October 24, 2014 Issue

The Department of Medical Services (DMAS) has posted a locality status page that provides current locality participation status relative to the three Medicare/Medicaid Plans (MMPs) participating in the Commonwealth Coordinated Care (CCC) program.  While it is not the VHCA-suggested format, it is clearly more user-friendly than utilizing the MMP comparison charts to try and figure out which MMP is in which locality.  Not explicit on the DMAS table, you should be aware that in a locality with only one MMP, “passive” enrollment, better known as auto-enrollment, is not allowed (two or more MMPs are required for auto-enrollment).  In other words, if the locality you are interested in only has one check mark, they are currently only allowing opt-in to CCC.  The DMAS locality status table can be found here, click on “MMP Participation by Locality”.

Sept 11 2014 CCC Map

Consider Sharing Provider Lists with Medicare/Medicaid Plans (MMPs) for CCC Participants in Your Facilities

Published in October 16, 2014 Issue

As previously communicated, Virginia Health Care Association continues to encourage members to provide physician and other ancillary provider lists to any MMPs with Commonwealth Coordinated Care (CCC) participants in your facilities if you have not already done so.  The MMPs have reiterated their willingness to pursue such providers for inclusion in their provider networks, or to at least consider temporary arrangements to achieve continuity of care until the CCC participants can be appropriately transitioned to MMP-networked ancillary providers.  While the type of provider may impact network inclusion (for example, a MMP may have an exclusive lab provider, so network inclusion for others may not occur), it is still in your interest to have the ancillary providers currently utilized by residents in your facility known to the MMP so that temporary payment arrangements can be made to minimize any potential for a break in services.  Contact lists with the MMPs provider relations/network leads can be found on our website here.

Sept 11 2014 CCC Map

DMAS Publishes CCC Provider Reference Guide, and Other CCC Updates

Published in October 10, 2014 Issue

The Department of Medical Assistance Services (DMAS) has published a Quick Provider Reference Guide specific to the CCC program on their website.  According to DMAS, the guide includes, among others:

RAI Manual Updates and CCC MDS Information

Published in September 25, 2014 Issue

The Virginia Health Care Association has received an update from Cil Bullard, RN, CPC, Virginia RAI/OASIS Coordinator, noting that the Centers for Medicare and Medicaid Services (CMS) has released the October 2014 RAI manual.  There are some identified issues with missing parts to the manual, as well as textual errors. CMS will be sending out an errata or updated manual which will be at the same site.  Ms. Bullard recommends if you print the manual that you wait until clarifications are released by CMS.  Among issues with the current release are missing item sets, incorrect or unclear text examples, and conflicting instructions. A webinar about the updates will be posted on the Virginia Department of Health website after the manual is finalized.

Sept 11 2014 CCC Map

CCC Updates

Published in September 11, 2014 Issue

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. 

UPDATED CCC MAP

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

Published in August 28, 2014 Issue

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).

Consider Sending Your Provider Lists to the MMPs

Published in August 14, 2014 Issue

REPRINT – Especially for Providers in the Next Phases of CCC Expansion (Western/Charlottesville; Roanoke; Northern Virginia).  One 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.

UPDATED CCC MAP

CCC Locality Participation Update

Published in August 14, 2014 Issue

As previously reported in the CareConnection, the Department of Medical Assistance Services (DMAS) has agreed to update and post a more user-friendly Commonwealth Coordinated Care (CCC) Locality Coverage Status table developed by VHCA.  Status is based first on the locality being in a demonstration region, and secondly, by the number of Medicare/Medicaid Plans (MMPs) with network coverage in the locality.  DMAS has not yet begun posting the table (we will communicate when that has occurred and how to access it online), but they did provide the following updates:

REPRINT: Please Consider Sending Your Provider Lists to the MMPs

Published in August 7, 2014 Issue

One 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 techs who draw 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.

EARLYBIRD REGISTRATION NOW AVAILABLE for the 2014 VHCA/VCAL Convention & Trade Show

Published in July 31, 2014 Issue

Maximize your membership investment and experience by joining your colleagues at the 2014 VHCA/VCAL Convention and Trade Show at The Richmond Marriott and the Greater Richmond Convention Center scheduled for September 15 - 18.  Plan to join in the festivities including the Regirer Nurse Scholarship Fundraiser Golf Tournament, Annual Awards Banquet, and Virginia’s largest long term care trade show. EARLYBIRD REGISTRATION NOW AVAILABLE.

Please Consider Sending Your Provider Lists to the MMPs

Published in July 31, 2014 Issue

One 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 draw 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.

Commonwealth Coordinated Care Update

Published in July 31, 2014 Issue

The Commonwealth Coordinated Care (CCC) program continues full speed ahead across the five demonstration regions. Currently, all five regions are active for voluntary or “opt-in” enrollment (within those regions, some localities may still be excluded due to network adequacy issues).  Tidewater was live for automatic, termed “passive”, enrollment for most eligible duals on July 1, with the remaining eligible Tidewater duals set for August (delayed from July due to a system issue at DMAS).  Central Virginia duals are scheduled for passive enrollment for coverage effective beginning September 1 and those folks should have received their letters with preliminary assignment to the Medicare/Medicaid Plans (MMPs).  That leaves the Roanoke region and the Charlottesville/Western region for passive enrollment coverage effective October 1 (letters should be going to recipients in August); and, the Northern Virginia region for passive enrollment coverage effective November 1 (letters to recipients should go out in September). 

Commonwealth Coordinated Care Update

Published in July 17, 2014 Issue

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. 

Commonwealth Coordinated Care Program Update

Published in July 10, 2014 Issue

As you have seen in the CareConnection in the last several months, the Commonwealth Coordinated Care (CCC) continues on its path to roll out across the five demonstration areas, the most recent milestone being the beginning of coverage in the Tidewater area under “passive” enrollment.  Passive enrollment means auto-enrollment of individuals eligible for the CCC program who have not explicitly opted-out, resulting in dual eligible CCC participation at volumes far exceeding what had previously been experienced through the recipient “opt-in” phase. 

Commonwealth Coordinated Care Update

Published in July 2, 2014 Issue

The Department of Medical Assistance Services (DMAS) and the Center for Medicare and Medicaid Services (CMS) will move Commonwealth Coordinated Care (CCC) automatic enrollment for the Northern VA region from October 1, 2014 to November 1, 2014.  Eligible individuals in the Northern Virginia region will continue to voluntarily enroll in CCC through October and, for those who do not opt-in to CCC or opt-out of CCC, their automatic coverage with CCC will begin November 1, 2014.  Letters informing eligible individuals of their upcoming automatic assignment will be received by September 1, 2014, sixty days prior to the effective coverage change.  The delay in automatic assignment will ensure network sufficiency with the Medicare-Medicaid Plans (MMPs), giving the health plans additional time to expand and diversify their provider networks.  The change also maximizes beneficiary choice by increasing provider options. 

CCC Program: Services for Passive Enrollees Effective in Tidewater July 1

Published in June 26, 2014 Issue

The Commonwealth Coordinated Care (CCC) program for Medicare/Medicaid fully dual eligible individuals (Duals) will enter into its first effective coverage of passively enrolled recipients on Tuesday, July 1 in the Tidewater CCC region.  Tidewater and Central Virginia were the first effective regions for CCC beginning this past April, but participation was limited to voluntary enrollment of beneficiaries in this initial implementation phase.  With passive enrollment, all Duals who did not explicitly opt-out of the program, or who are excluded for a limited number of reasons (such as having other third party insurance), have been automatically enrolled in one of the participating Medicare-Medicaid Plans (MMPs) in the Tidewater region (Initial passive enrollment assignment is currently underway in the Central region for coverage effective September 1).  Initial numbers from the Department of Medical Assistance Services (DMAS) indicate approximately 10,600 passively enrolled individuals in Tidewater will begin coverage in their assigned MMP on July 1 (the number of nursing facility residents within this total enrollment number has not yet been formally provided by DMAS to VHCA, but is believed to be slightly less than 1,500 – roughly half of initial estimates for nursing facility residents in Tidewater).

CCC Educational Materials Now Available

Published in June 20, 2014 Issue

Presentation materials from the Commonwealth Coordinated Care education conference held earlier this week are now available online for member use.  Please note that two of the files are placeholders for materials we have not yet received.  Please check back next week for those presentation files.

270/271 Technical Conference Call

Published in June 20, 2014 Issue

On behalf of our members, VHCA has requested that the Department of Medical Assistance Services (DMAS) send nursing facilities a monthly enrollment roster of their residents and patients who are enrolled in the Commonwealth Coordinated Care (CCC) program.  The DMAS real-time, web-based, automated response system (ARS) limits the provider’s verification submission to 10 members at a time.  DMAS has indicated that the Department does not have the system resources to be able to provide an enrollment roster to all interested providers each month.  However, DMAS has determined that a method for checking the eligibility/enrollment for up to 999 members at a time exists through the 270/271 HIPAA transaction, which is an industry standard method for supplying this type of information. 

Commonwealth Coordinated Care Update

Published in June 5, 2014 Issue

Despite the fact that less than four weeks remain until the launch of the Commonwealth Coordinated Care (CCC) program for passively enrolled dual eligibles in the Tidewater region, many unresolved issues and questions remain.  Through an ongoing series of member workgroup meetings, VHCA continues to meet with representatives from the Department of Medical Assistance Services (DMAS) and the three Medicare-Medicaid Plans (MMPs) to gain common approaches to a number of core operational processes.  While the next workgroup meeting is scheduled for June 24th, representatives from the three MMPs will be sharing their own organization’s care coordination plans during VHCA’s upcoming educational conference scheduled for June 17th and 18th in Richmond (see separate article).

Commonwealth Coordinated Care Update

Published in May 30, 2014 Issue

On May 28th, the Department of Medical Assistance Services (DMAS) communicated that problems had been discovered in the beneficiary assignment approach utilized to assigned dual eligibles to an individual Medicare-Medicaid Plan (MMP) within the Tidewater region of the Commonwealth Coordinated Care (CCC) program.  As a result, it appears that an unspecified number of individuals now receiving services in nursing facilities located within the Tidewater region will receive letters from the CCC enrollment broker, Maximus, indicating that they have been reassigned to a new MMP.  Based upon earlier DMAS projections of the number of dual eligible beneficiaries receiving nursing facility services in Tidewater, we estimate that as many as 600 individuals could be subject to the MMP reassignment.  The May 28th communication indicates that for the individuals being reassigned, their CCC coverage will begin August 1, 2014, one month later than previously announced.  The DMAS communication does not indicate how, or if, providers will be notified about which of their residents have been reassigned.

Commonwealth Coordinated Care Update

Published in May 15, 2014 Issue

Efforts and discussions continue as VHCA members work with leadership from the Department of Medical Assistance Services (DMAS) and representatives of all three health plans contracted to operate Virginia’s dual eligible financial alignment demonstration, the Commonwealth Coordinated Care (CCC) program, to address a number of operational issues that remain unresolved.  Earlier this week, a workgroup assembled to focus on several key claims and payment issues met with DMAS and all three Medicare-Medicaid plans (MMPs).

Commonwealth Coordinated Care Update

Published in May 2, 2014 Issue

Member facilities located in the Tidewater area of the Commonwealth are reporting the receipt of letters addressed to their residents announcing that they will soon be enrolled in one of three Medicare-Medicaid Plans (MMPs) and that their long term care services and supports will transfer to the Commonwealth Coordinated Care (CCC) program effective July 1, 2014.  The receipt of these passive enrollment 60-day letters is raising a number of questions from VHCA member facilities as they struggle with how to respond to questions from their residents.

Commonwealth Coordinated Care Update

Published in April 25, 2014 Issue

Beginning this week, individuals with full Medicare and Medicaid benefits in the Tidewater Region of the Commonwealth Coordinated Care (CCC) program will receive letters announcing that effective July 1, 2014 they will be assigned to one of three Medicare-Medicaid Plans (MMPs). The letter from the Virginia Department of Medical Assistance Services (DMAS) indicates that their traditional coverage provided through the Medicare and Medicaid programs will cease as of that date unless they choose to opt-out of the CCC. 

Commonwealth Coordinated Care Member Survey

Published in April 17, 2014 Issue

A VHCA online survey was launched on April 16th targeted to all member nursing facilities that are located within or adjacent to one of the five Commonwealth Coordinated Care regions.  The survey invitation was sent electronically to senior home office management for multi-facility organizations and to the administrator for freestanding nursing facilities.  We have requested that the online survey be completed no later than 5 PM on Tuesday, April 22nd.  No identifiable facility or organization information will be released or shared.

Commonwealth Coordinated Care Claims Testing

Published in April 17, 2014 Issue

One key element of preparation for the launch of the Commonwealth Coordinated Care (CCC) program is ensuring that providers have the ability to successfully transmit and submit claims to each of the three contracted Medicare-Medicaid Plans (MMPs) and for the MMPs to process those claims promptly and accurately.  Beginning in December 2013, VHCA began requesting that the Department of Medical Assistance Services (DMAS) require that MMPs establish the necessary resources to allow all nursing facilities to submit test claims to the health plans.  The response has been slow.  Late last week, DMAS provided a number of documents intended to serve as instructions and guidance to providers to move ahead with the testing of claims.  The claims testing information is available here.

Commonwealth Coordinated Care Update

Published in April 11, 2014 Issue

Despite a number of unresolved issues and many unanswered questions, the Department of Medical Assistance Services (DMAS) continues to move ahead with efforts to launch the Commonwealth Coordinated Care (CCC) program.  Beginning April 1st, approximately 1,400 dual eligible beneficiaries who voluntarily enrolled in the program began receiving services under the CCC.  According to information shared this week by DMAS, only 50 of these 1,400 individuals are residing in nursing facilities in the Tidewater and Central/Richmond regions of the CCC.

Commonwealth Coordinated Care: Third Party Liability Coverage

Published in April 11, 2014 Issue

Earlier this week, the Department of Medical Assistance Services (DMAS) issued a memorandum intended to provide clarity and guidance related to exemption criteria for beneficiaries eligible for enrollment in the Commonwealth Coordinated Care (CCC) program.  The specific item in question is exemption for individuals with other comprehensive group or individual health insurance coverage, referred to as TPL (third party liability) coverage. 

Commonwealth Coordinated Care Update

Published in April 3, 2014 Issue

Earlier this week, the Department of Medical Assistance Services (DMAS) released its April 2014 update covering the rollout of the Commonwealth Coordinated Care (CCC) program.  As of March 31st, a total of 1,417 individuals voluntarily enrolled in CCC in the Tidewater and Richmond/Central regions.  These voluntary enrollments represent 3.5% of the total Dual Eligible beneficiaries that reside in the two CCC regions.  Of the 1,417 voluntary enrollments, DMAS has indicated that only 14 beneficiaries are receiving services in nursing facilities.  Coverage for those who enrolled prior to March 26th began April 1, 2014. 

Commonwealth Coordinated Care Update

Published in March 28, 2014 Issue

Earlier this week, a second Commonwealth Coordinated Care (CCC) town hall meeting was held in Fredericksburg.  These meetings are intended to provide information about Virginia’s dual eligible financial alignment demonstration to both beneficiaries and providers, including nursing facilities.  Representatives from the Department of Medical Assistances Services (DMAS) report that approximately 1,500 individuals have initiated the process to enroll in the CCC voluntarily.  As of March 19, DMAS reported that only 14 dual eligible beneficiaries residing in nursing facilities in the Tidewater and Central/Richmond CCC regions had initiated voluntary enrollment efforts.

Commonwealth Coordinated Care Update

Published in March 21, 2014 Issue

An issue identified recently that may have significant implications for dual eligible resident populations in nursing facilities focuses on a provision in the three-way contract between the Centers for Medicare and Medicaid Services (CMS), the Department of Medical Assistance Services (DMAS) and the three contracted health plans (Medicare-Medicaid Plans or MMPs) that stipulates that beneficiaries with other insurance coverage are not eligible to participate in the Commonwealth Coordinated Care (CCC) program.  It is not uncommon for nursing facility residents to have Medicare supplemental insurance policies.  DMAS has indicated that traditional Medigap and Tricare policies indeed meet these criteria.  One primary concern related to this provision is that DMAS and its enrollment broker MAXIMUS do not maintain records that identify which dual eligible beneficiaries have supplemental insurance in effect.  Facilities are encouraged to identify residents with this type of coverage and communicate and clarify the CCC participation restriction to residents, resident’s families or their representatives with this coverage.