In our continuing effort to keep you up-to-date on the developments related to the launch of the Commonwealth Coordinated Care (CCC) Plus program, we have new information to share on several topics including:

• Two CCC Plans Not Yet Paying Under RUGs-IV
• Possible Incorrect Enrollments Based on the DSS Locality, Not the Resident Placement
• Regional Contact List for the CCC Plus Health Plans
• “Credentialing 101” Guide

Two CCC Plans Not Yet Paying Under RUGs-IV

VHCA-VCAL has confirmed that both Anthem HealthKeepers and Humana Gold Plus have not yet updated their system for the RUGs-IV 48.  As you know, effective for dates of service July 1, 2017 forward, Medicaid nursing center reimbursement is no longer under the RUGs-III 34 grouper, but has shifted to the RUGs-IV 48 grouper. 

It is our understanding that Anthem is utilizing the July 1 rates, but applying them against the old version of RUGs; it is not yet clear exactly how Humana is paying.  Anthem has indicated that they will have their system switched to the RUGs-IV 48 by the end of July; Humana has not committed to a correction date, according to the Department of Medical Assistance Services (DMAS).  Both Anthem and Humana will have to correct any claims submitted for dates of service from 7/1/17 forward for which they pay inaccurately.  Virginia Premier has successfully transitioned to the RUGs IV, according to DMAS. 

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

In the July 13 CareConnection, we advised of a procedure to dis-enroll individuals residing in a facility in a region not yet live under CCC Plus who are included in another region’s pre-assignment due to their Medicaid case file being maintained by a local DSS inside that region (the example of a NF resident in Charles City – Central Region for CCC plus – whose case is maintained in James City County – Tidewater region). 

DMAS has provided the following clarification regarding these situations:

• If it is in the best interest of the member, the NF or member or member’s care giver can let us know [Maximus – see below] and we will remove the CCC Plus enrollment segment.
  • We don’t want to disrupt the member simply because the FIPS is bad or even because a go-live date is a couple of months ahead, if the health plan can meet the needs.
• However, when in the Member’s interest we will delay their CCC Plus enrollment and will advise the member to notify (and we will notify) the DSS office to correct the member FIPS/address so that their FIPS/address in VAMMIS puts them in the correct region for CCC Plus assignment. 
• All enrollment errors / questions should be handled through the CCC Plus Helpline (Maximus).  Maximus will handle this as a request for exemption by the Member/Member’s representative.  Maximus will also advise the member’s responsible party to contact DSS to get the address corrected and will record the correct address information and DMAS will refer to the DMAS eligibility team to get the address corrected. 
  • Call the CCC Plus Helpline (Monday – Friday, 8:30 a.m. – 6:00 p.m.):   Toll-free:  1-844-374-9159 / TTY:  1-800-817-6608
    

Regional Contact List for the CCC Plus Health Plans

DMAS has posted the Regional Contact List for the CCC Plus Health Plans on its website. This document provides contact information by managed care organization (MCO) region by LTSS provider type. 

The contacts provided are for:

• Contracting
• Credentialing
• Notification/Authorizations
• Claims
• Care Coordination

As DMAS updates this file online, it will note a revision date.  We encourage you to periodically check that you have the most up-to-date version as the CCC Plus program goes live. 

“Credentialing 101” Guide

DMAS has also released a MCO credentialing guide as an information resource for providers considering network participation with the CCC Plus MCOs (here).  As of July 20, this document has not yet been posted to the DMAS website.