On September 19, VHCA-VCAL provided comments to the Department of Medical Assistance Services (DMAS) recommending changes for the January 1, 2019 CCC Plus contract revision. VHCA-VCAL reiterated the points it has made to the agency over the last year regarding prompt payment of nursing facility claims as members continue to struggle with receiving payment in 14 days.  The association suggests that “DMAS put this issue to rest by clarifying that the 14 days is inclusive of payment (either an EFT transaction within the 14 days or the actual cutting and mailing of a paper check within the 14 days).” 

VHCA-VCAL also recommended that the enforcement provisions in the contract should better reflect the seriousness of the persisting claims adjudication issues experienced by our membership. 

VHCA-VCAL offered additional specific recommendations on the following:

• Screening Requirements / Uniform Assessment Instrument (UAI) and their link to payment
• Annual LOC Review
• Standard Authorization
• Exceptional Processing and Payment
• Interest Payments
• Nursing Facility Mutual Aid Agreements
• Contractor Adverse Decisions
• Enforcement, Remedies, and Compliance

Click here to read the comments. 

DMAS solicited comments as part of its routine contract revision process.  Following review of any comments submitted to the agency, the agency will open another comment period on its suggested changes to the contract, if any.