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

Published in September 17, 2015 Issue

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.

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.

Transition to ICD-10 Less Than One Month Away

Published in September 3, 2015 Issue

October 1 is the effective date for the transition from the International Classification of Diseases (ICD) version 9 to version 10.  For service dates on or after October 1, 2015, usage of ICD-9 coding will result in claims processing denials and/or delays for both Medicaid and Medicare services, according to the Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS).

Medicaid Hospice Reimbursement to Become RUGs-Based July 1, 2015

Published in May 21, 2015 Issue

When Virginia Medicaid switched to RUGs-based billing for nursing facility care last November, the Department of Medical Assistance Services (DMAS) did not make the switch for Hospice providers based on both DMAS’ and the providers’ readiness for the change.  As you know, when a nursing facility resident enters hospice, the hospice provider is paid by Medicaid at 95 percent of the nursing facility rate; the hospice provider then pays the nursing facility based on the contract between the facility and the hospice provider.

DMAS Announces Delay in Patient Pay Claiming Changes

Published in March 20, 2015 Issue

In the February 25th CareConnection, we alerted you to a change in the way the Department of Medical Assistance Services (DMAS) would process patient pay adjustments under Medicaid for long term care recipients.  Subsequent to that article, we were told by each of the three Medicare/Medicaid Plans (MMPs) operating under the Commonwealth Coordinated Care (CCC) program that they intended to follow the new patient pay methodology that was outlined by DMAS for the fee-for-service program.

Price Based Reimbursement Update – RUGs Billing as of November 1st

Published in November 7, 2014 Issue

As you know, Virginia Medicaid has made the shift to individual RUGs-based billing for dates of service on and after November 1st.  DMAS has made some updates to the FAQs available on their website and we encourage you to review the questions and answers. 

November 1 Medicaid Rate Reminder (Reprint)

Published in October 30, 2014 Issue

November 1 is right around the corner.  As you know, effective for dates of service on or after November 1, Medicaid reimbursement for nursing facilities shifts from a facility case mix adjusted rate to individual RUGs rates based on the assigned RUGs weight – this is true for both Fee-for-Service and payment by the MMPs under the CCC Program.  Base rates and RUGs weights have been posted (scroll to “NURSING FACILITIES”), as have Frequently Asked Questions (same link).  Further, a Medicaid Memo providing billing guidance was posted September 26th (choose 2014, fifth down as of this publication).

November 1 Medicaid Rate Reminder

Published in October 24, 2014 Issue

November 1 is right around the corner.  As you know, effective for dates of service on or after November 1, Medicaid reimbursement for nursing facilities shifts from a facility case mix adjusted rate to individual RUGs weights based on the assigned RUGs weight – this is true for both Fee-for-Service and payment by the MMPs under the CCC Program.  Base rates and RUGs rates have been posted, scroll to “NURSING FACILITIES”), as have Frequently Asked Questions (same link).  Further, a Medicaid Memo providing billing guidance was posted September 26th (choose 2014, fourth down as of this publication).

November 1st Payment Methodology Update

Published in September 25, 2014 Issue

According to the Department of Medical Assistance Services (DMAS), the Medicaid Memo outlining billing procedures for the November 1st rate update will be posted today, September 26th (as of writing this article, the memo was not yet online).  As providers know, beginning for dates of service November 1st forward, claims will be reimbursed on an individual RUGs basis, as opposed to the facility case mix.  As such, the rates in effect currently expire October 31st, with new rates in effect beginning November 1st. Providers can access November 1st rates here.

billing

REGISTRATION STILL AVAILABLE - LTC Billing and Claims Management Workshops in TWO LOCATIONS

Published in July 17, 2014 Issue

The Long Term Care Billing and Claims Management Workshop, presented by Mary Lynn Wright, Revenue Cycle Consultant with The Wright Group, LLC, is a one-day course developed to provide a comprehensive review of third-party claims management for the long term care setting.  The program, scheduled July 22nd in Roanoke and July 23rd in Williamsburg, will provide attendees with the knowledge necessary to achieve a high rate of clean claim submission while decreasing risk of denials.  Payers addressed in this session are: Medicare A/B, Traditional Virginia Medicaid, managed care, and the transition to Commonwealth Coordinated Care (CCC) for dual eligible beneficiaries.  With CCC fully launched in Tidewater and coming to the rest of the Demonstration regions in the next few months, claims/billing procedures are evolving on a daily basis.  This workshop will provide up to the minute information that will assist you in working with the Medicare Medicaid Plans (MMPs) to get paid timely for the services you provide to CCC. 

CMS to Pilot “Settlement Conference Facilitation” for Part B Claims Appeals

Published in July 10, 2014 Issue

The Centers for Medicare & Medicaid Services (CMS) has just announced a new pilot, Settlement Conference Facilitation, which it hopes will alleviate some of the significant backlog of Medicare Part B claims being appealed to the Administrative law Judge (ALJ) level.  Settlement Conference Facilitation is an alternate dispute resolution process, designed to bring providers and CMS together to negotiate and settle some Medicare Part B disputes (e.g., only those appeals of Medicare Part B Qualified Independent Contractor (QIC) disputes) with the help of a settlement conference facilitator.  The facilitator will be an employee of the Office of Medicare Hearings and Appeals (OMHA), who will use mediation principles to help the parties come to a “mutually agreeable resolution.”  The facilitator will not make official determinations on the merits of the claims; but instead will help all the parties “see the relative strengths and weaknesses of their positions.”  If a resolution can be reached, a settlement document will be drafted to reflect the agreement, and the document will be signed by all the parties.  As part of the agreement, any provider requests for an ALJ hearing for the claims covered by the settlement will be dismissed.  To obtain more information and learn about eligibility and the process to request Settlement Conference Facilitation, go to the Department of Health and Human Services (HHS)/OMHA website

CMS Announces Proposed Rule for SNF PPS

Published in May 2, 2014 Issue

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the SNF Prospective Payment System. CMS is proposing a 2.0% increase, estimated to be $750 million for the profession. There are several aspects to this proposed rule that look positive. (A fact sheet is available on the CMS website.)  This rule reflects the third year in a row of market basket increases, and an increase from last year's 1.3% market basket update.  The key provisions in the SNF PPS proposed rule that could have a direct impact on the long term and post-acute care profession are highlighted below.

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 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.

Commonwealth Coordinated Care Update with Initial Medicaid Payment Rates

Published in March 13, 2014 Issue

Despite the fact that there are significant and important ongoing discussions between VHCA, the three contracted Medicare-Medicaid Plans (MMPs) and the Department of Medical Assistance Services (DMAS) to address a range of operational issues, DMAS is continuing its efforts to launch the Commonwealth Coordinated Care (CCC) program in accordance with their enrollment timetable for each of five CCC regions.  These discussions focus on three key areas: service authorizations, claims processing and payment determination (treatment of Medicare bad debts and Medicaid patient pay components), and care coordination. There is no formal mechanism for reporting the status of providers, including nursing facilities, that have contracted with Anthem HealthKeepers, Humana and Virginia Premier. It is our understanding that all three MMPs continue to work aggressively to negotiate and execute provider agreements.

DMAS Townhall Meeting Concerning the CCC Scheduled for March 5th in Virginia Beach

Published in February 20, 2014 Issue

The Department of Medicare and Medicaid Services (DMAS) is holding a Townhall meeting concerning the Commonwealth Coordinated Care Program (CCC) in Virginia Beach on March 5, 2014.  Click link for details.  Future Townhall meetings are also being scheduled in all CCC regions.  DMAS will provide additional information to these events when they are finalized.  Anyone who would like more information about Townhalls or would like to partner with DMAS to host a Townhall in your region, please contact DMAS at CCC@dmas.virginia.gov.

Fourth Quarter 2013 Medicaid CMI Report Problems

Published in February 20, 2014 Issue

Virginia nursing facilities have received their quarterly reports from Myers and Stauffer (formerly Clifton Gunderson) for Third Quarter 2013 (Final) and Fourth Quarter 2013 (Preliminary). The Fourth Quarter Preliminary CMI should have been calculated using October 1 - December 31, 2013. Instead, it appears to have been calculated using October 31 - December 1, 2013, thereby omitting about a third of the Medicaid census that should have been included. Many providers have contacted Myers and Stauffer or the Department of Medical Assistance Services (DMAS) about discrepancies in these reports. 

Commonwealth Coordinated Care Update

Published in February 6, 2014 Issue

As a follow-up to a December 2013 meeting of VHCA’s ad-hoc managed care committee, association staff recently met with the Department of Medical Assistance Services (DMAS) to address a number of issues identified by the committee.  An outcome from the January meeting with DMAS was DMAS’ agreement to host a series of additional meetings with all three contracted MCOs and VHCA member representatives to try and work through key operational concerns that must be resolved prior to the Commonwealth Coordinated Care (CCC) launch.  To date, two workgroup meetings have been held focusing on a number of issues including authorizations, preauthorizations, reauthorizations, patient pay, Medicare bad debt, and claims submission and testing. Additional meetings will take place through February and possibly into March to wrap up discussions on these topics as well as to address the overall process surrounding care coordination and the transition/discharge planning process.

Minimum Wage Initiative Tied to Services Provided to VA Patients

Published in January 30, 2014 Issue

On Tuesday, President Obama issued an executive action regarding the minimum wage increase for new federal contract workers.  In advance of this week’s State of the Union address, the White House released some details about the executive action that would raise the minimum wage from $7.25 to $10.10 for new federal contract workers by 2015.  It is important to note that this executive action does not impact Medicare or Medicaid providers, as it is a long-standing policy that such providers are not "federal contractors."  It is also important to note that if long term care facilities serve VA patients, those facilities are considered to be federal contractors, and thus, this executive action may apply.

DMAS Reports Medicaid Billing Concern

Published in January 23, 2014 Issue

The Department of Medical Assistance Services (DMAS) reports that it is experiencing an increase in complaints related to hospitals not being able to receive payment for services rendered due to some nursing facilities failure to adjust the admission date on their claims when a resident returns from the hospital. When nursing facilities leave the original admission date on submitted claims, it causes an edit to set within the DMAS claims processing system and the hospital is not paid.  This issue can create large outstanding balances for hospitals.

Commonwealth Coordinated Care Update

Published in January 9, 2014 Issue

Earlier this week, the Department of Medical Assistance Services (DMAS) released a Commonwealth Coordinated Care (CCC) update.  The launch dates for the CCC, Virginia’s dual eligible demonstration, have been revised slightly from previous communications.  DMAS indicates a one-month delay from the original dates due to the extended time required to finalize the three-way contract.  With this adjustment, the timeline for passive enrollment has been shifted accordingly to allow for a gradual implementation.  As a result, services for beneficiaries passively (automatically) enrolled in the Tidewater Region will begin July 1 and the service start date for Central Virginia beneficiaries will shift to August 1.  Following is the revised enrollment timetable for each region in the Commonwealth:

Workgroup Approves Medicaid Price-Based Payment Transition

Published in January 9, 2014 Issue

Earlier today, the Department of Medical Assistance Services (DMAS) Nursing Facility Medicaid Payment Workgroup voted to approve the transition from Virginia’s cost-based payment system to a price-based methodology.  Capping off over two years of analysis and development, members of the workgroup voted in favor of specific language that would begin to implement a fully prospective price-based payment methodology starting July 1, 2014.  The DMAS workgroup is comprised of representatives of all three associations representing nursing facilities – VHCA, the Virginia Hospital and Healthcare Association and the Virginia Association of Nonprofit Homes for the Aging.  The overall move to price-based payment is viewed as a key factor in transitioning successfully to managed care under Commonwealth Coordinated Care – Virginia’s dual eligible financial alignment demonstration.

Commonwealth Coordinated Care Update

Published in December 19, 2013 Issue

On December 17th, members of the VHCA’s Ad-Hoc Managed Care Committee met with representatives of all three health plans that have been selected by the Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS) to participate in Virginia’s Commonwealth Coordinated Care program (CCC or dual demonstration). The meeting was structured to allow the committee to meet with the three managed care organizations (MCOs) separately for purposes of discussing the status of efforts by each health plan to address a range of operational issues that are considered essential to the successful coordination of activities and communications between MCOs and nursing facilities.

Commonwealth Coordinated Care Update

Published in December 12, 2013 Issue

As communicated yesterday in a broadcast email to our members, the Department of Medical Assistance Services (DMAS) provided the final three-way contract dated December 4, 2013 to VHCA earlier this week.  The three-way contract is the key legal agreement between the federal Centers for Medicare and Medicaid Services (CMS), DMAS and each individual participating health plan necessary to form the Commonwealth Coordinated Care (CCC or dual demonstration) program.

Commonwealth Coordinated Care - Virginia's Dual Demonstration

Published in November 14, 2013 Issue

Earlier this week we sent out an email to nursing facility administrators and corporate offices announcing the availability of a side-by-side comparison of key provisions and observations related to each of the managed care contract templates approved by the Department of Medical Assistance Services for the three MCOs that have been selected to participate in the Commonwealth Coordinated Care program (CCC).

Commonwealth Coordinated Care Program

Published in November 6, 2013 Issue

We continue to encourage our members to consider delaying the execution of contracts with MCOs especially in light of the fact that the “three-way contract”, the core agreement between the Centers for Medicare and Medicaid Services (CMS), DMAS and each of the MCOs, has not been finalized and the blended payments to MCOs have not been formally established.  One additional key element that we understand will be addressed in the three-way contracts is the provision for prompt payment as it relates to MCO payments to providers.  While there are no guarantees, we anticipate that the three-way contracts may be finalized over the next two to four weeks.

Commonwealth Coordinated Care Update

Published in November 1, 2013 Issue

VHCA has been informed by the Department of Medical Assistance Services (DMAS) that all three managed care organization (MCO) contract templates for the Commonwealth Coordinated Care program (CCC or the dual demonstration) have been approved.   As described by DMAS, each of the three MCOs (Virginia Premier, Humana, and Anthem HealthKeepers) may now begin talking with individual nursing facilities regarding participation in the CCC program.

Commonwealth Coordinated Care: DMAS Approves Humana Provider Agreements

Published in October 23, 2013 Issue

Late last week, the Department of Medical Assistance Services (DMAS) announced that they had approved templates of Humana’s provider participation agreements under the Commonwealth Coordinated Care (CCC or dual demonstration) program.  This approval included the nursing facility contract.  After discussion with DMAS staff, it appears that the Department has approved two Humana documents, a base contract titled “Ancillary Provider Contract” and a separate Nursing Facility Addendum.  According to DMAS, both documents will be sent to nursing facilities within the five CCC regions that currently do not have a contract with Humana.  Nursing facility providers who currently have a contract with Humana will only be sent the Nursing Facility Addendum.  We are pleased to report that based upon our initial review of the contracts, it appears that Humana has agreed to pay providers no less than the established Medicaid and Medicare rates paid to nursing facilities. 

REMINDER: We Need Your Input on an Important Issue Impacting Your Residents

Published in October 23, 2013 Issue

The Virginia Health Care Association is working with Dr. Patricia Bonwell, a Professor with Virginia Commonwealth University, and a task force formed by the Virginia Dental Association (VDA) to better understand the problems related to accessing dental services for residents of Virginia's long term care facilities. Specifically, the task force is focused on enhancing access to services and oral health among Medicaid beneficiaries in nursing facilities.

Save the Date: November AHCA Webinar on Medicare-Medicaid Demonstrations

Published in October 17, 2013 Issue

Critical phases of the Medicare-Medicaid Coordination Demonstration such as three-way contracts and open enrollment periods are currently in place in select states.  Additional states, including Virginia are expected to roll out similar coordination demonstrations.

Commonwealth Coordinated Care Update and the Future of Medicaid Payment

Published in October 17, 2013 Issue

As we reported last month, in late September the Department of Medical Assistance Services (DMAS) announced in an email message that the agency had approved provider agreements submitted by Virginia Premier Health Plan, Inc. including the plan’s nursing facility agreement.  The message also indicated that DMAS had approved all agreements submitted by HealthKeepers (Anthem/WellPoint) except for the nursing facility agreement.  Finally, the Department indicated that none of the provider agreements submitted by Humana have been approved at this time.  Virginia Premier officials stressed that the approved plan will serve as a template for individual provider agreements and provides the flexibility to incorporate contact provisions that foster innovative and effective approaches for care coordination.

Commonwealth Coordinated Care Update

Published in September 26, 2013 Issue

On September 24th, the Department of Medical Assistance Services (DMAS) announced in an email message that the agency had approved provider agreements submitted by Virginia Premier Health Plan, Inc. including the plan’s nursing facility agreement.  The message also indicated that DMAS had approved all agreements submitted by HealthKeepers (Anthem/WellPoint) except for the nursing facility agreement.  Finally, the Department indicated that none of the provider agreements submitted by Humana have been approved at this time.  VHCA has obtained a copy of the Virginia Premier agreement and is now reviewing the document.  Virginia Premier officials stress that the approved plan will serve as a template for individual provider agreements and provides the flexibility to incorporate contact provisions that foster innovative and effective approaches for care coordination.

UPDATE: Commonwealth Coordinated Care

Published in September 6, 2013 Issue

As a reminder to our members and due to its significance, we’re repeating portions of a CareConnection article published on August 1st.  Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS) continue to move forward with the development and implementation of Virginia’s demonstration for a blended Medicare-Medicaid program for dual eligibles – now known as Commonwealth Coordinated Care (CCC).

Update: MCO Provider Agreements

Published in August 9, 2013 Issue

Commonwealth Coordinated Care

Last week, the Virginia Health Care Association was informed verbally by leadership of the Department of Medical Assistance Services (DMAS) that all proposed provider agreements between health plans and nursing facilities under Virginia’s Commonwealth Coordinated Care program must be submitted by the managed care organization (MCO) to DMAS for review and approval prior to execution.  VHCA’s Managed Care Committee is working with DMAS to ensure that provider agreements contain essential provisions that will allow facilities to provide post-acute and long term care services to dual eligible beneficiaries free of unnecessary administrative oversight and require health plans to pay providers fairly and promptly for those services.

UPDATE: Commonwealth Coordinated Care

Published in August 1, 2013 Issue

On July 31st, representatives from the Department of Medical Assistance Services (DMAS) presented an update to members of the Commonwealth Coordinated Care Advisory Committee.  DMAS and the Centers for Medicare and Medicaid Services (CMS) are moving forward with the development and implementation of Virginia’s demonstration for a blended Medicare-Medicaid program for dual eligibles – now known as Commonwealth Coordinated Care (CCC).

CMS Issues Final Rule for Hospice in Nursing Centers

Published in August 1, 2013 Issue

On June 27, 2013, the final rule Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services was published in the Federal Register. The Final Rule revises skilled nursing facility (SNF)/nursing facility (NF) requirements for arranging provision of hospice care and primarily focuses on the information that must be contained in an agreement for hospice services between a hospice and nursing center.  Facilities must be in compliance by August 26, 2013 according to the preamble of the regulation, “This final rule sets forth requirements consistent with requirements in the June 5, 2008 final rule (73 FR 32088) titled ‘‘Medicare and Medicaid Program: Hospice Conditions of Participation.’’  This final rule also supports current LTC requirements that protect a resident’s right to a dignified existence, self-determination, and communication with, and access to, persons and services inside and outside the facility.”

UPDATE: OIG Advisory on Checking LEIE for Exclusions

Published in August 1, 2013 Issue

In the July 24th CareConnection we published an article on the Health & Human Services Office of Inspector General’s (OIG) Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, issued May 8, 2013.  This updated Special Advisory Bulletin describes the scope and effect of the legal prohibition on payment by Federal health care programs for items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person.

Commonwealth Coordinated Care: MCO Contracting

Published in July 3, 2013 Issue

Due to the significant potential impact for our members, we are repeating this article from last week's CareConnection.  The Department of Medical Assistance Services (DMAS) along with the Centers for Medicare and Medicaid Services (CMS) recently announced that they have selected three managed care organizations (MCOs or health plans) to participate in Virginia's dual demonstration - Commonwealth Coordinated Care.  The awardees are Anthem HealthKeepers, Humana and Virginia Premier.  Each of these three health plans will compete in all five demonstration regions.  A 10-day protest period is now underway to allow unsuccessful health plans to appeal the DMAS/CMS decision.

DMAS Announces MCO Awardees for Commonwealth Coordinated Care

Published in June 28, 2013 Issue

Late today, we received information from the Department of Medical Assistance Services (DMAS) that the agency, in conjunction with the Centers for Medicare and Medicaid Services (CMS), has selected three managed care organizations (MCOs or health plans) to participate in Virginia’s dual demonstration – Commonwealth Coordinated Care.  The awardees are Anthem HealthKeepers, Humana and Virginia Premier.  Each of these three health plans will compete in all demonstration five regions.  A ten-day protest period now begins to allow unsuccessful health plans to appeal the DMAS/CMS decision.

Now Available: Medicaid Information Clearinghouse

Published in June 19, 2013 Issue

The American Health Care Association & the National Center for Assisted Living (AHCA/NCAL) launched its first online Medicaid Information Clearinghouse last week.  The new tool is available exclusively for AHCA/NCAL members and is a one-stop shop to get answers and resources on the Medicaid program.

VHCA Provides Comments to VHRI

Published in June 5, 2013 Issue

On August 16, 2010, Governor Bob McDonnell announced the membership of the Virginia Health Reform Initiative (VHRI) Advisory Council. The Council’s objectives include the provision of recommendations to the Governor towards a comprehensive strategy for implementing health reform in Virginia. The Advisory Council is made up of leaders from the legislature, health care delivery, health care policy, health insurance, and business communities.

CMS Revises Guidance Related to Improving Care for Persons with Dementia and Reducing Antipsychotic Drug Use in Nursing Facilities

Published in June 5, 2013 Issue

The Centers for Medicare & Medicaid Services (CMS) has released two new Survey and Certification Memos revising guidance on care for persons with dementia, consistent with the goals of the Partnership to Improve Dementia Care in Nursing Homes to, “optimize quality of life and function of residents in America’s nursing homes by improving approaches to meeting the health, psychosocial and behavioral health needs of all residents, especially those with dementia.”  The new guidance emphasizes the need to individualize care and treatment approaches and to ensure that antipsychotic medications are used only when a clear and appropriate clinical indication exists.

Medicaid Testing New Rug Grouper

Published in June 5, 2013 Issue

Last week, the Department of Medical Assistance Services (DMAS) announced via a communication included in each Medicaid-participating nursing facility’s GoFileRoom that it is evaluating a new version of the Resource Utilization Group (RUG).  The RUG-IV grouper was first available on October 1, 2010.  The Medicaid version of this grouper contains 48 RUG categories.  The evaluation of the Medicaid RUG-IV 48 group version is one component of work now underway to develop, and possibly implement, a new price-based Medicaid payment methodology in Virginia.

RAI Manual Update

Published in May 30, 2013 Issue

The RAI Manual v1.10 posted on May 20, 2013 by the Centers for Medicare & Medicaid Services (CMS) omitted six sections: Chapter 3 - Section F; Chapter 3 - Section J; Chapter 3 - Section S title page; Appendix D; Appendix F title page; and Appendix H title page.  The re-posting of RAI Manual v1.10 on May 29, 2013, now includes these six sections.

CMS & Virginia Announce Dual Demonstration MOU

Published in May 22, 2013 Issue

On May 21st, the Centers for Medicare & Medicaid Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS) announced that they will establish a Federal-State partnership to implement the Commonwealth Coordinated Care program (also referred to as the Dual Demonstration) to better serve individuals eligible for both Medicare and Medicaid (dual eligibles).  The Federal-State partnership will include a three-way contract with managed care organizations (MCOs) that will provide integrated benefits to Medicare-Medicaid Enrollees in the targeted geographic area(s).  The Demonstration will begin on February 1, 2014 and will continue until December 31, 2017, unless terminated earlier in accordance with provisions of the executed Memorandum of Understanding (MOU).  The demonstration is intended to test a payment and service delivery model to lessen the fragmentation and improve coordination of services for Medicare-Medicaid Enrollees, enhance quality of care, and reduce costs for both the Commonwealth and the federal government.

Dual Demonstration Update

Published in May 9, 2013 Issue

Virginia providers are paying increasing attention to the status of the proposed Medicare/Medicaid financial alignment demonstration (the Dual Demonstration).   Despite the belief that the Centers for Medicare and Medicaid Services (CMS) would issue a Memorandum of Understanding (MOU) to the Commonwealth in April, the federal agency has not yet added Virginia to the short list of states with approved MOUs.  Senior leadership at the Department of Medical Assistance Services (DMAS) believes the release of the MOU to be imminent.

Skilled Nursing Profession Responds to CMS Proposed Payment Rule

Published in May 9, 2013 Issue

Recently, the American Health Care Association (AHCA) issued a statement from President and CEO Mark Parkinson in response to the release of the Skilled Nursing Prospective Payment System (SNF PPS) Proposed Rule for FY2014 by the Centers for Medicare and Medicaid Services (CMS):

DMAS Updates Ceiling Tables

Published in May 1, 2013 Issue

The Virginia Department of Medical Assistance Services (DMAS) has updated their cost ceiling tables for Medicaid-participating nursing facilities and posted them here.  The revised ceiling tables reflect the approved 2.2% inflation update effective July 1, 2013 and reports ceiling amounts for direct and indirect components for days of service through June 30, 2014.

Dual Eligible Financial Alignment Demonstration: DMAS Issues RFP to MCOs

Published in April 17, 2013 Issue

The Department of Medical Assistance Services (DMAS or the Department) formally issued a Request for Proposals (RFP) on April 10th from managed care plans (plans or MCOs) to enter into risk-based contracts for the capitated model under the Medicare-Medicaid Financial Alignment Demonstration (the Demonstration).

Dual Demonstration Update

Published in March 25, 2013 Issue

During a recent meeting with representatives of managed care organizations, staff of the Department of Medical Assistance Services (DMAS) shared some news and their updated regional implementation timing expectations with respect to Virginia’s proposed Medicare/Medicaid Financial Alignment Demonstration (Dhttp://www.vhca.org/IlluminAgeApps/whatsnewApp/files/5CD65A34C.pdfual Demonstration). 

Final Rule Published on Notice of Facility Closure

Published in March 25, 2013 Issue

On March 19th the Centers for Medicare & Medicaid Services (CMS) published the Final Rule on Requirements for Long-Term Care Facilities related to “Notice of Facility Closure” in the Federal Register with an effective date of April 18, 2013.   This rule adopts technical changes to the interim final rule, published on February 18, 2011, that implemented Section 6113 of the Affordable Care Act (ACA), requiring that individuals serving as Administrators of a SNF or NF provide written notification of impending closure and plan for relocation of residents at least 60 days prior to the closure or, if the Secretary terminates the facility’s participation in Medicare or Medicaid, not later than the date the Secretary determines appropriate.  The full text of the rule can be found here.  

VHCA Submits Comments to CMS: Dual Demonstration Proposal

Published in June 29, 2012 Issue

Earlier this week, the Virginia Health Care Association (VHCA) submitted written comments to the Centers for Medicare and Medicaid Services (CMS) related to a proposal submitted by the Department of Medical Assistance Services (DMAS) for a blended payment demonstration for dual eligible beneficiaries that, if approved, would provide capitated combined Medicare and Medicaid funding to managed care organizations (MCOs).  These MCOs would in turn, contract with providers, including nursing facilities, for the delivery of coordinated services to individuals with both Medicare and Medicaid benefits. The comments, developed in conjunction with the association’s ad-hoc committee on managed care, are available here (member log-in required).

 

FINAL CALL: Virginia’s Dual Demonstration Comment Period Ends June 30th

Published in June 22, 2012 Issue

The Virginia Health Care Association (VHCA) encourages all members to forward comments, questions and suggestions to the association related to the proposed Medicare/Medicaid Alignment Demonstration as we work to finalize comments that will be submitted to the Centers for Medicare and Medicaid Services (CMS).  The official end of the comment period is Saturday, June 30th.  VHCA plans to submit written comments on Wednesday, June 27th.  A draft of the association’s comments is available for your information and review.

Nursing Home Quality Improvement Questionnaire Announced

Published in June 22, 2012 Issue

The American Health Care Association (AHCA) has asked affiliates to assist the Centers for Medicare & Medicaid Services (CMS) in announcing a Nursing Home Quality Improvement Questionnaire that will be administered this summer by a CMS contractor.   The collection of this information is part of the CMS advancement of Quality Assurance and Performance Improvement (QAPI) in nursing homes.   The contractor will identify a representative sample of 4,200 nursing homes that will receive an invitation to complete the questionnaire.  The goal of the questionnaire is to identify the quality systems and processes nursing homes currently have in place, as well as assess the extent to which these systems and processes function to help nursing homes recognize and address quality issues. This information will help CMS and the contractors refine the QAPI components. Members are encouraged to participate if selected.  An Information Sheet describes the questionnaire as well as some of the other initiatives under way.

Virginia Dual Demonstration: CMS Comment Period Ends June 30th

Published in June 15, 2012 Issue

The Virginia Health Care Association (VHCA) encourages all members to forward comments, questions and suggestions to the association related to the proposed Medicare/Medicaid Alignment Demonstration as we work to finalize comments that will be submitted to the Centers for Medicare and Medicaid (CMS) on or before June 30th.

We Need Your Voice!

Published in February 3, 2012 Issue

To echo the old quote that just showing up is a significant part of achieving success, we need all members to be in Richmond in two weeks to meet with legislators in person and to describe for them the real world consequences of trying to deliver high quality long term care services while Medicaid payment rates are facing a fifth consecutive year of cuts.  Your voice is critical! 

CMS Releases Medicaid RAC Q&A

Published in February 3, 2012 Issue

The Centers for Medicare & Medicaid Services (CMS) recently released a Medicaid RAC Q&A that discusses operational guidance to States and general information regarding its Medicaid RAC program. The Affordable Care Act, section 6411(a) expanded the Medicare Recovery Audit Contractor (RAC) program (now Recovery Audit program) to Medicaid and requires each State Medicaid program to establish a RAC program, absent an exception, to enable the auditing of claims for services furnished by Medicaid providers.

DMAS Announces 2011 Wage Survey

Published in January 13,2012 Issue

The Department of Medical Assistance Services (DMAS) has posted a GoFileRoom request that nursing facilities provide wage data to support the development of inflation factors for the nursing home rate setting. Completion of the wage survey is mandatory for all non-hospital based nursing facilities participating in Virginia Medicaid.  The data is needed to support the development of rates and must be collected in a manner more timely than cost reports. Therefore, DMAS requires all non-hospital based facilities to complete this annual wage survey.

Clarification on Process for Admitting Medicaid MCO Beneficiaries

Published in January 6,2012 Issue

The Department of Medical Assistance Services (DMAS) has notified us that they have been receiving numerous phone calls related to admissions of individuals with Medicaid Managed Care Organizations (MCO) who are seeking nursing facility placement.  The introduction of Medicaid managed care for populations requiring primary and acute care in the Roanoke area is likely driving most of the calls from nursing facilities.  The process for admitting Medicaid MCO individuals into the nursing facility is the same for both MCO and non MCO individuals.  Once the individual is admitted into the nursing facility, the facility must submit the PIRS (Patient Intensity Rating System, DMAS-80) form within 30 days of admission or notification of financial Medicaid eligibility to the Long Term Care Division at DMAS.  This information can be found in the Virginia Medicaid Nursing Facility Manual Chapter VI.  

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Financial Performance and Medicaid Cost Survey Underway

Published in January 6,2012 Issue

The Virginia Health Care Association (VHCA) is working with members of the Payment for Services Committee to develop updated nursing facility cost and financial performance information that will be used during the 2012 General Assembly Session.  In connection with this effort, VHCA is utilizing a facility-specific survey designed to collect two sets of data that are critical in assisting the Association as we work with legislators to address inadequate Medicaid funding in Virginia.  The survey tool in an Excel spreadsheet set up so that organizations with multiple facilities can input data for all facilities within a single workbook file.  While the initial request was to our Payment for Services Committee whose members represent the majority of facilities in Virginia, we’re asking that all VHCA facility members that participate in the Medicaid program complete the survey.

Virginia Medicaid Reforms Get Tentative CMS Nod

Published in February 20, 2013 Issue

The Centers for Medicare and Medicaid Services (CMS) has indicated its general approval to a series of reforms that Governor McDonnell and his administration proposed as a precondition to expanding Virginia’s Medicaid program under the Affordable Care Act.  CMS issued a letter last week to Virginia Secretary of Health and Human Resources William Hazel to outline areas of agreement between the federal and state governments, as well as the additional steps that lie ahead before reforms can be put fully into place.

Medicaid CMI and RUGs Reports Now Available

Published in February 14, 2013 Issue

We have been asked to remind our members that Medicaid final Third Quarter 2012 and preliminary Fourth Quarter 2012 Quarterly Resident and Facility CMI/RUGS reports have been posted to GoFileRoom.  Facilities with questions or problems about GoFileRoom or accessing the reports should contact DMAS.GoFileRoomsupport@mslc.com.

Important Update: Virginia's Proposed Medicare/Medicaid Financial Alignment Demonstration for Dual Eligibles

Published in January 31, 2013 Issue

The Virginia Department of Medical Assistance Services (DMAS) submitted a proposal in late May 2012 to the Centers for Medicare and Medicaid Services (CMS) to implement a three-year pilot which would combine Medicare and Medicaid funding for dual eligible beneficiaries.  All health care services provided to these individuals would be coordinated through, and payment made by, health plans (managed care organizations or MCOs) in each of the designated geographic areas comprising the Demonstration.

DMAS Announces 2012 Wage Survey

Published in January 16, 2013 Issue

The Department of Medical Assistance Services (DMAS) has posted a GoFileRoom request that nursing facilities provide wage data to support the development of inflation factors for the nursing home rate setting.  Completion of the wage survey is mandatory for all non-hospital based nursing facilities participating in Virginia Medicaid.  The data is needed to support the development of rates and must be collected in a manner more timely than cost reports.  Therefore, DMAS requires all non-hospital based facilities to complete this annual wage survey.

Post Election: All Eyes on Washington

Published in November 13, 2012 Issue

Medicare cuts will be harmful to residents and providers, according to a new ad campaign unveiled this week by the American Health Care Association (AHCA).  Launched on Monday, AHCA’s week-long ad blitz brings the sector’s concerns with possible Medicare funding cuts directly to the nation's lawmakers.

CMS Clarifies Guidance on Medication Errors and Pharmacy Services

Published in November 7, 2012 Issue

On November 2, 2012, CMS (the Centers for Medicare & Medicaid Services) distributed a Survey & Certification Memo (S&C: 13-02) providing guidance on three specific topics related to medication errors and pharmacy services.

  • Medication Errors: Potential medication errors related to medication administration via feeding tube and administration timing for metered dose inhalers and proton pump inhibitors and survey implications.
  • Medication Administration Practices: The practice of “borrowing” medications and issues related to diversion, control, reconciliation and disposal of medications, including fentanyl patches.
  • Medication Regimen Reviews for Stays under 30 days and/or Changes in Condition: The need for pharmacist medication regimen reviews when a resident experiences a change in condition and/or for residents admitted for less than 30 days.

The clarification provides specific Guidance to surveyors for deficiency citations.  The S & C memo notes that additional tags are provided as “links” for the surveyors.  In Virginia medication administration [technique, error, and administration] are consistently being cited under multiple tags, including F332; F333; F281; F425, etc.  The Guidance is effective immediately.

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Medicare & Medicaid Information Notice

Published in October 31, 2012 Issue

In recent months we have become aware of several facilities that were surveyed and cited because they did not have information related to Medicare and Medicaid benefits and coverage for nursing facility services prominently displayed to comply with guidance on F-156:

§483.10(b)(10) -- The facility must prominently display in the facility written information, and provide to residents and applicants for admission oral and written information about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits.

Since information on how to apply for Medicare and Medicaid benefits is not covered in the Resident Rights poster and there does not appear to be a commercial poster that would meet the requirement, VHCA and VANHA have developed a sample document as written information that facilities can “prominently display” in their buildings which satisfies the requirement in the F156 guidance.  The Office of Licensure And Certification has reviewed the sample document and agrees that it satisfies the intent of the law.  The sample document posted on our website is an 8½ x 11.  If you wish to receive an 11 x 17 poster, contact Kathy Robertson in the VHCA office at 804.212.1700 or via email.  Please be sure your facility prominently posts the information in a location where it can be easily viewed. 

OIG Releases 2013 Work Plan

Published in October 31, 2012 Issue

The Department of Health and Human Services’ (HHS), Office of Inspector General (OIG) has released its annual Work Plan for 2013.  The Work Plan focuses on seven different areas including:  Medicare Part A and Part B; Medicare Part C and Part D; Medicaid Reviews; Legal and Investigative Activities Related to Medicare and Medicaid; Public Health Review; Human Services Reviews; and Other HHS-related reviews.  In each area, the Work Plan identifies compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives.  Under Medicare Part A and Part B, SNFs are specifically targeted and OIG plans follow-up reports in the following areas:  Adverse Events in Post-Acute Care; Quality of Care Requirements; State Agency Verification of Corrections; Oversight of Poorly Performing Facilities; Use of Antipsychotic Drugs; Questionable Billing Patterns for Part B Services; and Oversight of the Minimum Data Set.  Overall, OIG will continue its trend to focus its efforts on reviewing potential areas to discover fraud, quality issues and costs.  To obtain a copy of the complete OIG Work Plan for 2013, click here.  OIG also has just released a video on its Work Plan for 2013.

Court Case Settlement May Broaden Skilled Services

Published in October 24, 2012 Issue

The post-acute and long term care sector is closely following Medicare’s decision to start paying nursing facility, home care and physical therapy bills for some patients who were previously denied coverage.  Historically, Medicare regulations eliminated coverage of skilled nursing and home care services if patients were not shown to be improving. The care in question might have been physical therapy for stroke victims, home nurse visits for those with Alzheimer’s or post-hospital nursing facility care for diabetics.  Once their health status no longer reflected improvement or started deteriorating, Medicare would stop paying.

Behavioral Issues Survey Coming This Week

Published in October 17, 2012 Issue

Over the past year, VHCA has seen an increase in multiple survey citations, including abuse and safety, related to resident behaviors. We are now challenged with a CMS national initiative to reduce the use of antipsychotic drugs in nursing home residents by 15% by the end of 2012, based on the CMS claim that too many residents with dementia are receiving antipsychotic medications inappropriately. There has also been an increase in inquiries about the limited availability of mental health services for residents with behaviors and the costs associated with providing care to respond to the behaviors and to protect other residents and staff. VHCA created a Behavior Management Workgroup to explore opportunities for providing additional resources to our members to assist them in successfully addressing resident behavioral issues within their organizations.

CMS Releases Revised Surveyor Guidance and Updates to Appendix P

Published in October 11, 2012 Issue

The Centers for Medicare and Medicaid Services (CMS) recently posted advance copies of revised surveyor guidance and updates to Appendix P of the State Operations Manual. The changes to Appendix P are to be implemented no later than December 1st and include Survey Protocols for LTC Facilities revised for the traditional survey process.  Tasks 1 - 5 C reflect changes for the following:

  • Minimum Data Set (MDS) 3.0;
  • New Quality Measures (QM) Reports;
  • Sampling and reviewing residents receiving psychopharmacological medications, specifically antipsychotic medications.

Dual Demonstration Update: MCO to Meet with VHCA Committee

Published in September 26, 2012 Issue

Following up on last week’s news related to outreach efforts by managed care organizations (MCOs) as part of their planning for possible participation in Virginia’s proposed Medicare/Medicaid payment alignment pilots (Dual Demonstration), this week we had a request from Virginia Premier, a health plan affiliated with Virginia Commonwealth University, to meet for purposes of sharing information and perspectives related to facility-based long term care services.

MCOs Begin Dual Demonstration Dialogue with Nursing Facilities

Published in September 20, 2012 Issue

Earlier this week, we received word from a member facility in Northern Virginia that they were visited by representatives of a managed care organization (MCO) to discuss the facility’s participation in the MCO’s Dual Demonstration network should they be awarded a contract by the Centers for Medicare and Medicaid Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS).  As previously reported, Virginia is one of 26 states seeking CMS approval to implement a three-year pilot which would combine Medicare and Medicaid funding for dual eligible beneficiaries.  All health care services provided to these individuals would be coordinated through, and payment made by, MCOs in each of four designated geographic areas comprising the Demonstration.  Under the proposal, 164 of 267 Virginia Medicaid-participating nursing facilities (61.4%) are located in one of the four pilot areas.  Beneficiaries would be automatically enrolled effective January 1, 2014.

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Compliance Program Alert

Published in August 22, 2012 Issue

Written by Martin A. Donlan, Jr., Esquire

Nursing homes now face audits by Medicare and Medicaid recovery audit contractors (“RACs”) (overpayment auditors), Medicare and Medicaid integrity contractors (fraud auditors), as well as standard Medicare and Medicaid cost report and utilization review auditors such as PHBV Partners, LLP (formerly, Clifton Gunderson, LLP) who are ever more aggressive than in the past.  These auditors rely upon their successful retraction of payments for their continued contracting, not to mention that some receive direct incentive payments.  Accordingly, the scrutiny of your medical and billing records will now be more intense. 

DMAS Holds Dual Demonstration Care Coordination Workgroup Meeting

Published in July 31, 2012 Issue

The Virginia Department of Medical Assistance Services (DMAS) held a workgroup meeting in Richmond on Friday, July 27th intended to begin a discussion about issues related to service coordination within the proposed Dual Eligible Demonstration. The workgroup members included advocates, managed care organizations that have expressed an interest in participating in the Demonstration, public and governmental agency representatives and providers.  Provider groups represented on the workgroup included nursing facilities, hospitals, home care and hospice, PACE centers, adult day care centers and personal care providers.  Physicians were not represented on the workgroup.

CMS Releases 5010 Implementation Reminder

Published in July 25, 2012 Issue

In June, the Centers for Medicare & Medicaid Services (CMS) released an updated and revised document in MLN Matters regarding the enforcement of the Health Insurance Portability and Accountability Act (HIPAA) 5010 transaction standards that became effective July 1, 2012.  As providers know, Medicare (in most instances) requires the use of electronic claims in order for providers to receive Medicare payments; providers must now submit these claims electronically using the Accredited Standards Committee Version 5010.  This MLN Matters document reminds long term care providers that the implementation of HIPAA 5010 presents substantial changes in the content of the data that providers submit with claims, as well as the data available to providers in response to electronic inquiries.  The implementation requires changes to the software systems and perhaps procedures that providers use for billing Medicare and other payers.  Most of these changes have already been implemented by provider’s vendors.  To obtain a copy of the document, click here.

New Five-Star Ratings for Individual Facilities

Published in June 29, 2012 Issue

The American Health Care Association (AHCA) has notified us that as of last week nursing facilities were able to access their new Five-Star rating and quality measure information via the CASPER on-line reporting system.  The Centers for Medicare & Medicaid Services (CMS) announced that they anticipate releasing this information publicly via Nursing Home Compare  on July 19th.  Changes to the Nursing Home Compare website that facilities and consumers will see as of that date include updates to the look, feel and some functionalities as well as new information, including:

DMAS Submits Modified Dual Eligible Proposal to CMS

Published in June 1, 2012 Issue

On May 31st, the Department of Medical Assistance Services (DMAS) submitted its proposal to the Centers for Medicare and Medicaid Services (CMS) to implement a Dual Eligible Integration Demonstration in Virginia.  Based upon communications between VHCA’s Ad-hoc Medicaid Managed Care Committee and DMAS, the Department incorporated two key changes requested by VHCA in their final proposal.  The proposal now contains a provision that managed care organizations (MCOs) must enter into provider contract with any willing nursing facility that has a Medicaid provider agreement in place.  Additionally, under the Demonstration, MCOs must pay no less than the equivalent fee for service Medicaid rate payment as determined by DMAS.

CMS Pilot Overview for Staffing Payroll Participants

Published in May 24, 2012 Issue

The Centers for Medicare & Medicaid Services (CMS) is seeking nursing homes to participate in the Payroll Based Nursing Home Staffing Data Collection (PBNHSDC) Pilot.  This pilot is testing a method to measure staffing turnover, retention and levels quarterly from payroll data.  CMS intends to implement this data collection process nationally in late 2013 or early 2014. 

DMAS to Issue Interim Nursing Facility Rate Increase

Published in May 11, 2012 Issue

Based upon recent discussions with senior staff of the Department of Medical Assistance Services (DMAS), we’re happy to pass along news that in early July nursing facilities will begin receiving an interim rate adjustment for dates of service on or after July 1, 2012.  This increase results from additional Medicaid funding included in the Commonwealth’s 2012-2014 Biennium Budget.

VHCA Provides Comments to DMAS on Draft Dual Eligible Proposal

Published in May 11, 2012 Issue

As previously reported, the Department of Medical Assistance Services (DMAS) is proceeding with its efforts to develop and implement a demonstration to integrate care and payment for dual eligible (Medicare and Medicaid) beneficiaries in Virginia.  On April 13th, the Department published a public comment draft of its proposal to the Center for Medicare and Medicaid Services’ Center for Medicare and Medicaid Innovation.

Initial Observations on the DMAS Dual Eligible Demonstration Draft Proposal

Published in April 20, 2012 Issue

The Virginia Department of Medical Assistance Services (DMAS) posted its Dual Eligible Demonstration draft proposal to the Center for Medicare and Medicaid Innovation (CMS) as scheduled on April 13th.

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VHCA and DMAS Meet to Discuss Dual Eligible Payment Demonstrations

Published in April 13, 2012 Issue

The Virginia Health Care Association’s Ad-Hoc Committee on Managed Care held its initial meeting on Wednesday, April 4, 2012 in the association’s office in Richmond.  For this meeting, committee members were joined by Cindi Jones, Director of the Department of Medical Assistance Services (DMAS) and other senior staff from the Department. 

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DMAS Holds Initial Dual Eligible Stakeholder Meetings

Published in March 23, 2012 Issue

On Wednesday, March 21st the Department of Medical Assistance Services (DMAS or the Department) held the first in a series of meetings intended to gain stakeholder involvement and support for its proposed plan to integrate care for Medicare-Medicaid enrollees or dual eligibles.  Two sessions were held on the 21st – a two-hour general information session followed by a meeting focused on issues related to nursing facilities and hospitals.

CMS Announces Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

Published in March 23, 2012 Issue

This new effort aims to improve the quality of care for people residing in nursing facilities. The Centers for Medicare & Medicaid Services (CMS) is currently accepting applications to participate in this initiative.

CMS will support organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs.  The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations. This initiative supports the Partnership for Patients' (http://innovation.cms.gov/initiatives/Partnership-for-Patients/index.html) goal of reducing hospital readmission rates by 20% by the end of 2013.



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Update on DMAS Dual Eligible Integration Pilots

Published in March 9, 2012 Issue

Cindi Jones, Director of the Department of Medical Assistance Services (DMAS), recently announced that Virginia plans to move forward with three geographic pilot programs designed to better coordinate the care provided to Medicare-Medicaid enrollees.  It is our understanding that DMAS intends to pursue managed care pilot programs in the Northern Virginia, Richmond/Charlottesville and Tidewater regions of the Commonwealth.  Under the pilot programs, long term care services provided to dual eligible (Medicare-Medicaid) enrollees would likely be coordinated and paid for by managed care organizations who have been awarded a three-way contract between the Center for Medicare and Medicaid Services (CMS), DMAS and the health plan.  According to Ms. Jones, DMAS is planning to pursue pilot programs that would automatically enroll all dual eligible beneficiaries within the designated geographic regions and that an opt-out provision would likely be available.

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DMAS Moving Forward With Dual Eligible Integration Pilots

Published in March 2, 2012 Issue

During last week’s VHCA/VCAL Legislative Conference in Richmond, Cindi Jones, Director of the Department of Medical Assistance Services (DMAS), announced to attendees that Virginia plans to move forward with three geographic pilot programs designed to better coordinate the care provided to Medicare-Medicaid enrollees.  According to information provided by the American Health Care Association (AHCA), 23 states are either planning for some form of Medicaid managed care for long term care services or have already implemented managed care programs.

We Need Your Voice!

Published in January 27, 2012 Issue

To echo the old quote that just showing up is a significant part of achieving success, we need all members to be in Richmond next month to meet with legislators in person and to describe for them the real world consequences of trying to deliver high quality long term care services while Medicaid payment rates are facing a fifth consecutive year of cuts.  Your voice is critical!