Commonwealth Coordinated Care Plus Update – January2018
We are pleased to provide you with the following important updates on the Department’s Commonwealth Coordinated Care (CCC) Plus program.
Background
Beginning August 1, 2017, the Department of Medical Assistance Services (DMAS) launched the CCC Plus Managed Care program in the Tidewater region for full Medicaid Members who are either 65 or older, children or adults with disabilities, nursing facility residents, and those receiving services and supports through a home and community based waiver. As of January 1, 2018, Commonwealth Coordinated Care Members and Medallion 3.0 Aged, Blind and Disabled individuals were effective in CCC Plus bringing enrollment to over 210,000 individuals.
As new CCC Plus Members become eligible each month, Medicaid mails an enrollment letter and program information to the Members. The new CCC Plus program provides medical, behavioral health, substance use disorder, and long term services and supports services– all under one program. The program includes the additional benefit of a care coordinator assigned to each Member. Detailed information on CCC Plus populations, services, and regional implementation schedule is available on the CCC Plus webpage.
Welcome DirectorJennifer Lee, MD
Dr. Jennifer Lee is the new DMAS Director. Her extensive health care experience includes serving as an emergency physician, Deputy Secretary of Health and Human Resources under Secretary Dr. Hazel and Governor McAuliffe, and most recently as the Deputy for Policy and Services for the new Under Secretary of Health in the Department of Veterans Affairs. Dr. Lee continues the DMAS commitment toprovide a system of high quality and cost effective health care services to qualifying Virginians and their families.
Provider Networks
Health plans continue to build their provider networks. Providers may contact provider relations at each health plan to initiate a conversation about joining a network. As a reminder, health plans do not have to accept any willing provider into their networks but are responsible to have a sufficient network that ensures access to quality services covered under CCC Plus. See the Contracting and Credentialing Contact Information for the participating health plans.
CCC Plus Health Plan Websites
Aetna Better Health /Anthem HealthKeepers Plus /
Magellan Complete Care of VA /
Optima Health Community Care /
UnitedHealthcare Community Plan /
Virginia Premier Health Plan /
CCC Plus Enrollment as of 1/10/2018
MCO / Tidewater / Central / Charlottesville / Roanoke Alleghany / Southwest / Northern VA/ Winchester / TotalAetna / 5,838 / 9,114 / 3,980 / 3,579 / 3,968 / 5,038 / 31,517
Anthem / 12,260 / 15,482 / 5,434 / 4,908 / 3,532 / 14,917 / 56,533
Magellan / 7,661 / 5,073 / 3,034 / 2,665 / 2,274 / 3,728 / 24,435
Optima / 9,554 / 7,216 / 7,506 / 2,421 / 2,631 / 3,307 / 32,635
United / 4,982 / 5,062 / 2,322 / 3,508 / 2,395 / 7,194 / 25,463
VA Premier / 4,843 / 9,355 / 6,862 / 8,300 / 6,426 / 3,954 / 39,740
Total / 45,138 / 51,302 / 29,138 / 25,381 / 21,226 / 38,138 / 210,323
CCC Plus Enrollment by Age
The CCC Plus program currently serves:
Youth under 21 / Adults 21-64 / Seniors 65 +28,466 / 114,215 / 67,723
2018 CCC Plus Health PlanContract and Rates
The January renewal of the CCC Plus Contract was fully executedfor all sixCCC Plus health plans. The 2018 contract and rates areavailable on the DMAS website.
Health Plan Business Processes
Health plans are required to cover services within at least equal timeliness, amount, duration, and scope as available within the Medicaid fee-for-service program. This does not preclude the health plan from having different business processes, including for service authorization, credentialing, andother measures designed to ensure quality, efficiency, and program integrity.
DMAS, health plans and stakeholders worked together to successfully streamline the process for certain services, including: nursing facility, hospice, adult day health care, private duty nursing, personal care, respite, home health, services facilitation, addiction and recovery treatment services (ARTS), and community mental health rehabilitation services (CMHRS). These processes are available on line in the charts for how to do business with each health plan by provider type.
For children enrolled in early intervention (EI), the health plan is required to follow very prescriptive guidelines. Health plans are not allowed to impose service authorization requirements for EI services and must provide coverage for these services using the DMAS recognized procedure codes, criteria, and guidelines. The health plan must also pay EI services at no less than the DMAS rate. The guidelines for early intervention services are detailed in guidance documents that are available on the DMAS website.
Health PlanReimbursement Rates to Providers
Reimbursement rates paid by the CCC Plus health plan for enrolled Members aregenerally governed by the contract that the provider has in place with the Member’s health plan. However, health plans are required to pay at no less than the Medicaid rate for the following services: nursing facilities, hospice, long-term services and supports (e.g., adult day health care, private duty nursing, personal care, respite, and services facilitation), EI, ARTS, and CMHRS.
Medicare Coordination of Benefits
On December 29, 2017, DMAS released a Medicaid Memo about CCC Plus and Coordination with Medicare. CCC Plus health plans do not require the Medicare provider to be in their network or obtain an authorization prior to payment of a Medicare crossover claim. CCC Plus health plans are working with the Center of Medicare and Medicaid Services to finalize their Coordination of Benefits Agreement (COBA). Once finalized, DMAS will send out a memo with further information.
Continuity of Care Period
Prior to April 1, 2018, the continuity of care period to maintain the Member’s current providers and service levels is up to 90 days. The health plan will honor the service authorizations issued by DMAS or the prior DMAS Contractor for the length of the existing service authorization or 90 days (whichever is sooner). The health plan will extend this timeframe as necessary to ensure continuity of care pending theprovider’s contracting with the health plan or the Member’s safe and effective transition to a contracted provider. On or after April 1, 2018, the continuity of care period to maintain the Member’s current providers is for up to 30 days, and the health plan will honor the service authorizations issued by DMAS or the DMAS Contractor for the length of the existing service authorization or 30 days (whichever is sooner). The health plan will extend this timeframe as necessary to ensure continuity of care, pending the provider’s contracting with the health plan or the Member’s safe and effective transition to a contracted provider.
For information on how to bill as an out of network provider, please see Appendix B of the Medicaid Memo about CCC Plus and Coordination with Medicare.
Update on CCC and ABD Transition
CCC members in Anthem, Humana and Virginia Premier Medicare-Medicaid Plans transitioned to CCC Plus on January 1, 2018. Please see the CCC Close Out Memo for more information.
Pharmacy
Dual eligible members with questions aboutfillingprescriptions or related to prescription drug copays should call 1-800-MEDICARE (1-800-633-4227). Medicaid only members should contact their health plan Care Coordinator for questions related to prescription drugs. Please see updated phone numbers below.
Pharmacists and providers can find additional information and Pharmacy Help Desk Phone numbers on the Pharmacy webpage.
Transportation
Please check eligibility to determine which health plan the member is in and then visit the CCC Plus transportation page for updated contact information. UnitedHealthcare has switched transportation vendors in the Central, Roanoke/Alleghany and Southwest regions. The phone number is (844) 604-2078.
Care Coordination
To reach a health plan Care Coordinator, please use these updated phone numbers.
Aetna / Anthem / Magellan / Optima / UnitedHealthCare / VA Premier1-855-652-8249 press #1 and ask for Care Coordination. / 1-855-323-4687 Press #4
TTY 711 / 1-800-424-4524 / 757-552-8398 OR Toll Free:1- 866-546-7924 / Members: 1-866-672-7982
Providers: 1-877-843-4366 / 1-877-719-7358;
Select prompts:
3-3-4-1
Consumer Direction
For assistance regarding a personal care attendant and payment, please first check with your Service Facilitator or Care Coordinator. Secondly, please contact the Public Private Partnership (PPL) helpline at 1-866-259-3009 or email: .
Transition of Community Mental Health Rehabilitation Services (CMHRS) to CCC Plus
On January 1, 2018, CMHRS transitionedinto the CCC Plus health plan contract, utilizing DMAS’ current CMHRS coverage criteria and program requirements. CMHRS coverage for Medallion 3.0 members will continue to be administered through Magellan of Virginia until the implementation of Medallion 4.0 later in 2018. Magellan of Virginia will continue to manage the CMHRS services for individuals enrolled in the DMAS fee-for-service program.Residential services are carved out of CCC Plus.
Additionally, all CCC Plus health plans are required to pay the CMHRS providers using established DMAS reimbursement rates as the minimum payment level. There are no changes made to current program regulations, medical necessity criteria, procedure codes, and unit values for these services at this time. The CMHRS standardized forms, Authorization Process, Provider Reference Guide, CMHRS provider training recorded webinars and more information are available on the CCC Plus website under CMHRS Transition. Please see Medicaid Memo released on October 23, 2017 on Transitioning Community Mental Health Rehabilitation Services into the CCC Plus Program for more information.
Providers should contact the CCC Plus health plan for any missing authorizations or incorrect units authorized by the health plan. Please see the CMHRS Reference Guide – doing business with the health plans for contact information.
Care Coordination in Action: One-step at time
Last Spring a Medicaid Member with multiple chronic conditions became unable to walk. He went to an inpatient acute hospital, returned home and then required emergency nursing facility placement. The Medicaid Member was enrolled in CCC Plus in the Fall and asked about transitioning out of the nursing facility during his health risk assessment. The Member agreed to physical therapy to strengthen his legs and improve his ambulation.
The health plan Care Transition Team, including the Care Coordinator, Transition Coordinator and Social Worker at the nursing facility worked together with the Member to establish a timeline for transitioning Member back to the community. Several needs were identified including, Section 8 accessible housing, funding for a security deposit and first month’s rent, home furnishings, food, home health services, physical therapy, occupational therapy, a wheel chair and other medical equipment. The team worked together to locate appropriate housing and furnishings and set up necessary services. The Member moved into his apartment and then realized he needed a hospital bed and lift chair. The health plan Care Coordinator ordered new furniture to meet the Member’s needs. The Member is doing well, getting out with a walker and meeting neighbors. He has visitors and goes shopping.
Outreach and Education
Provider conference calls are continuing. The next call is February 14, 2018 from 12:30 – 1:15pm. Dial 1-866-842-5779 and enter Conference Code: 9318957138. See the CCC Plus Provider Schedulefor the full list.
DMAS launched a new conference call series with a focus on Community Mental Health and Rehabilitation Services on Fridays from 11:00am- 12:00pm. Dial 1-866-842-5779 and enter Conference Code: 7143869205. See the CMHRS Provider Call Schedule for the full list.
Please save the date for the next CCC Plus Advisory Committee meeting on March 27, 2018 1:00 – 3:00pm at DMAS, 600 East Broad St, Richmond VA 23219.
If you have questions or concerns about CCC Plus for DMAS, please email the CCC Plus inbox, for assistance.
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