DMAS: Mandatory Managed LTSS Enrollment Delayed; CCC Won’t be Extended

This week the Department of Medical Assistance Services (DMAS) announced significant changes in its plans for managed Medicaid Long Term Support Services (MTLSS).  At the DMAS Board meeting on September 15, Director Cindi Jones announced that the agency will not move forward with previously announced plans to mandate a Medicaid managed care product for CCC-eligibles in 2016 for those individuals who had opted-out of the program (this was termed Phase 1 of the expansion of managed long term care). DMAS has also said it is no longer planning to extend the Commonwealth Coordinated Care (CCC) program beyond December 2017.

Earlier this year DMAS had said it would implement a two phase expansion of managed long term care. Phase 1 would have mandated a Medicaid managed care product for CCC-eligibles who had opted out of the program on or about July 2016 administered by the same three CCC MMPs.  Phase 2, called MLTSS, would be a mandatory Medicaid managed care product for the non-CCC regions of the state (duals and otherwise) and the non-dual or non-CCC eligible recipients in the CCC regions on or about July 2017, with an RFP for plan selection (i.e., not necessarily the same plans as in CCC)

Jones did specify that the agency would still move forward with Phase 2 with a July 2017 target implementation date.  The CCC program will continue through the original end date of December 2017, but will not be extended beyond that time frame.  Given the timing of MLTSS and the expiration of CCC, the agency will procure MLTSS statewide for all long-term care populations (duals and non-duals).  The remaining CCC participants will transition to MLTSS at the expiration of CCC.

DMAS has also discussed a new initiative called the “Delivery System Reform Incentive Program (DSRIP)” and implied that it will coincide with and include the MLTSS program described above.  From the initial information provided, DSRIP seems to be a reform of Medicaid reimbursement to a more value-based purchasing arrangement.  DMAS is currently holding regional meetings across the state on DSRIP and will be releasing a concept paper next week.  As it stands today, it is unclear how this program interacts with MLTSS and the nursing facility provider community, but we will be discussing this more as details emerge.

In summary:

  • Phase 1 – Medicaid mandatory managed care for CCC-eligibles who opted out – is no longer planned.
  • Phase 2 – Managed Long Term Services and Supports (MLTSS) – is on schedule for July 2017, but now represents the statewide model for all long-term care Medicaid recipients, including the CCC population once CCC expires.
  • CCC will not be extended beyond December 2017.
  • DMAS is working on a new reform effort, Delivery System Reform Incentive Program (DSRIP), which will likely impact our membership, but that impact is yet to be determined.

DMAS acknowledged that stakeholder input had a significant impact on the agency’s decision to modify its implementation plans for managed long term care.  VHCA is grateful for members’ input into this process and DMAS’ continued willingness to involve stakeholders.     

It is important to note that DMAS’ plans are evolving.  We will provide additional details as they are available.