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As August 1 approaches, we are inching closer to the beginning of the Commonwealth Coordinated Care (CCC) Plus program phased launch, several important updates are coming out from the Department of Medical Assistance Services (DMAS) and the managed care organizations (MCOs) on the following:

• Enrollment information contained in eDocManagement report
• Possible incorrect enrollments based on the DSS locality, not the resident placement
• Transportation brokers
• Claims readiness
• LTSS Provider Orientation hosted by Anthem

CCC Plus Enrollment Information Contained in eDocManagement Report

DMAS has communicated to VHCA-VCAL that the nursing facility enrollment reports are available through your eDocManagement access.  This “Facility Enrollment Report” is supposed to contain enrollment data specifying the CCC plus plan participation (it also contains CCC – the Dual Demonstration – participation).

For Tidewater, the report should show the pre-assignment data; this could change based on the resident’s decision to switch MCOs prior to coverage, but the next update (after July 18) should contain the correct assignment data for the month of August.  VHCA-VCAL is following up with DMAS on the plan indicators – appears to include a MCO NPI.

Even if you are not in the Tidewater region, it would be useful to familiarize yourself with the report in preparation for your region’s go-live.  Also, you may identify any possible issues with misassignment of the CCC Plus region for your residents.  After July 18, the report will also show pre-assignment information for the Central region in advance of its September 1 go-live date. 

Possible Incorrect Enrollments Based on the DSS Locality, Not the Resident Placement

VHCA-VCAL has discussed with DMAS the circumstance where a nursing facility (NF) resident’s Medicaid case resides in one CCC Plus region while the actual NF placement is outside that region.  For example, a resident’s Medicaid case could be processed in James City County (Tidewater CCC Plus region) but the resident lives in a NF in Charles City County (Central CCC Plus region).  The resident is assigned to Plan A for August 1 go-live but is not actually in the Tidewater region (should be assigned later for a September 1 go-live since they are in the Central region).  This type of scenario occurred under the CCC Dual Demonstration. 

Different from the Dual Demonstration, however, because DMAS is tackling network adequacy on a regional basis for CCC Plus, there are currently no “approved” plans yet outside of Tidewater.  Thus, if the example above occurs, the resident is assigned to a plan not yet approved by DMAS.  As such, DMAS would need to dis-enroll the resident until the go-live date in the region based on the resident’s actual NF location.  DMAS has asked that we notify the Department if/when we see this issue. 

VHCA-VCAL is aware that at least one member company has identified this issue outside of Tidewater.  Because the relevant information to dis-enroll would contain protected health information (PHI), we have requested DMAS guidance on how the agency would like us to alert them of this issue.  We are working to confirm both the policy and procedure with DMAS on how this process will work.  We will provide you with an update as soon as we receive one.

Transportation Brokers

DMAS has communicated the list of transportation brokers to VHCA-VCAL for each of the six MCOs.  While we had hoped for more uniformity for administrative ease, there will be multiple vendors with which nursing center staff will need to coordinate depending on the plan, and in one MCO’s case, the region.  Here is the information provided by DMAS:

• Aetna’s transportation broker is LogisiCare
• Anthem Healthkeepers transportation broker is Southeastrans
• Magellan’s transportation broker is Veyo
• Optima Health is Southeastrans
• United Healthcare has two transportation brokers:
  • Southwest, Roanoke/Alleghany, and Central Regions – Liberty
  • Tidewater, Western/Charlottesville and Northern/Winchester Regions – MTM
• VA Premier will coordinate its transportation internally

Claims Readiness

Unfortunately, VHCA-VCAL is not yet able to report that claims testing with the CCC Plus MCOs and our member facilities has been completed successfully.  We had been pressing for claims readiness testing for several months now, which DMAS eventually indicated was not technically feasible through the agency. 

With this news, VHCA-VCAL reconvened the claims processing subcommittee of our Ad Hoc Committee on Managed Care.  This group met with DMAS and the MCOs on June 13 to figure out the testing scenarios and procedures.  In hopes of having results to share, a second meeting was scheduled for earlier this week (July 10). 

While we had hoped to have results of testing at the meeting this week, delays by DMAS and the MCOs in providing information and specifying the procedures did not make that outcome feasible.  However, it appears that test claims are being communicated now and we are hopeful to have meaningful feedback on testing by the next scheduled meeting of the group on July 24.  We will share those results as soon as we have them. 

Anthem Hosting LTSS Provider Orientation

Anthem HealthKeepers Plus, a CCC Plus MCO, has asked VHCA-VCAL to inform you that it is hosting a series of webinars to orient providers to its network for CCC Plus. 

The event flyer provides the schedule and access information.  Per the flyer, “Online sessions will include information about provider responsibilities, precertification and preauthorization, claims submission, appeals and denials, and common billing errors.”

These webinars will be held as follows:

• July 14, 2017 2 p.m. to 3:30 p.m.

• July 18, 2017 10 a.m. to 11:30 a.m.
• July 18, 2017 2 p.m. to 3:30 p.m.
• July 20, 2017 10 a.m. to 11:30 a.m.
• July 25, 2017 10 a.m. to 11:30 a.m.
• July 25, 2017 2 p.m. to 3:30 p.m.
• July 27, 2017 10 a.m. to 11:30 a.m.
• July 27, 2017 2 p.m. to 3:30 p.m.