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).

“Doc Fix” Bill Update

Published in April 2, 2015 Issue

As you know, the United States Senate recessed for two weeks without taking up the “Doc fix” (Sustainable Growth Rate) legislation passed by the House of Representatives late last week.  The “Doc Fix” is a recurring policy issue where the annual formula for updating physician payment under Medicare results in a significant reduction relative to current physician payment.  In order to avoid the formula driven reduction, Congress typically passes legislation “fixing” the payment to maintain current payment levels.  In order to do so, Congress must come up with the required funding, which has often lead to reduction in other provider payment updates, including nursing facility payments under Medicare.

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 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 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.

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.

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:

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.

Empty Hospital Bed

Observation Stays Issue Update

Published in December 12, 2013 Issue

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Representatives Joe Courtney (D-CT) and Tom Latham (R-IA), along with Senator Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.  The number of co-sponsors since the bills were introduced earlier this year have increased significantly.  Currently, S. 569 has 24 bipartisan co-sponsors, while H.R. 1179 has 125 bipartisan co-sponsors.  AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 19 organizations advocating for this important legislation.  Most recently, The Jewish Federations of North America (JFNA) joined the efforts.  In addition to AHCA/NCAL and JFNA, Coalition members include:  AARP, AMDA, American Case Management Association, American Medical Association, Alliance for Retired Americans, Center for Medicare Advocacy, Inc., Leadership Council of Aging Organizations, LeadingAge, Medicare Rights Center, National Academy of Elder Law Attorneys, National Association of Professional Geriatric Care Managers, National Association of State Long-Term Care Ombudsman Programs, National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, National Senior Citizens Law Center, and Society of Hospital Medicine.  The updated Coalition fact sheet can be found here.  For more information about observation stays, visit the AHCA/NCAL website.

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. 

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.

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.

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.

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.

INTERACT Unnecessary Hospitalizations Initiative

Published in November 7, 2012 Issue

Under the leadership of Joseph G. Ouslander, MD, Florida Atlantic University is participating in a CMS (Centers for Medicare and Medicaid Services) initiative to reduce unnecessary hospitalizations of nursing home residents.  The project is designed to rigorously evaluate implementation of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program.  

INTERACT is a quality improvement program that focuses on the management of acute changes in nursing home resident condition. It includes educational resources and clinical practice tools and strategies for their use in everyday practice in nursing homes.

CMS Releases Schedule for Manual Medical Review Phase-In

Published in August 29, 2012 Issue

The Middle Class Tax Relief and Job Creation (MCTRJC) Act of 2012 extended the Medicare Part B outpatient therapy cap exceptions process through December 31, 2012.  Through the exceptions process, providers may receive payment for therapy services above the $1,880 cap on outpatient therapy (OT), and the $1,880 cap on physical therapy (PT) and speech language pathology (SLP) services combined, when they are reasonable and medically necessary, require the specialized skills of medical professionals, and are justified by supporting documentation in the patient’s medical record. The MCTRJC Act also required that providers submit a request for an exception for therapy services above the threshold of $3,700 for OT, and $3,700 for PT and SLP services combined. These requests for exceptions will be manually medically reviewed. Providers will be required to submit requests for exceptions to the threshold in advance of furnishing therapy services above the threshold.

New Nursing Home Salary and Benefit Survey Report Available

Published in August 15, 2012 Issue

The Hospital & Healthcare Compensation Service (HCS) 2012/2013 Nursing Home Salary and Benefit Survey Report is now available.  The report, supported by the American Health Care Association, covers information on salaries and wages for 42 management and 45 nursing, therapy, dietary, and clerical positions, as well as benefit information, for various geographic areas.  AHCA members may purchase the report at the reduced rate of $225.  See the HCS website for more information.

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.

Guidance for Providers When Confronted with a Subpoena for Records that Include PHI

Published in June 15, 2012 Issue

As healthcare oversight activities are increasing, the American Health Care Association (AHCA) Legal Committee has determined that it would be helpful to furnish basic information to members on what they should do when confronted with a subpoena for records that might include protected health information (PHI).  Accordingly, AHCA’s Legal Committee worked with General Counsel, Reed Smith, and developed a primer