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Update on Cardinal Care Managed Care

CareConnection October 12, 2023

Update on Cardinal Care Managed Care

What’s happening: CMS recently approved DMAS’s application to combine its managed care waivers and operate a single managed care program through Cardinal Care Managed Care, effective October 1, 2023.

  • Full implementation of the contract may require between 30 – 60 days. Over the next few months, DMAS will phase out use of the CCC Plus and Medallion 4.0 managed care program names. The CCC Plus long term services and supports home and community-based services (HCBS) Waiver will continue to operate as CCC Plus HCBS.
  • Cardinal Care Managed Care includes all existing managed care populations and services, maintains enrollment of the member with their current MCO, and provides a foundation for Gov. Youngkin’s priority initiatives, including Right Help Right Now and the Managed Care Procurement.

 

How it will work: The transition to Cardinal Care Managed Care is expected to be seamless for members and providers.

  • Members and providers do not need to take any action to enroll in Cardinal Care; members remain enrolled with their managed care plan and can continue to see their current providers.
  • Cardinal Care Managed Care will also improve the member experience by eliminating a drop to fee-for-service when members transition from Medallion to CCC Plus (or vice versa), such as when members need long term services and supports.
  • Mitigation of gaps in the member’s MCO enrollment will also lead to improved claims and service authorization transactions for providers. Additional details are provided in the table below. 

 

Take a look at what stays the same and what is different under Cardinal Care Managed Care:

Stays the Same under
Cardinal Care		 Will Change under Cardinal Care
  • Members and providers do not need to take any action to enroll in Cardinal Care and members remain enrolled with their current plan and plan providers. 
  • Improves continuity for members by no longer requiring transitions between MCO programs. 
  • Other than the improvements for three areas listed below, the Cardinal Care Managed Care transition is expected to be seamless for members and providers.  
  • Same included and excluded managed care populations.
  • Same managed care covered services, although aligns some that were treated differently within the two programs, (see next column.)
  • Same managed care carved-out services (DD Waiver services, dental, etc.) 
  • Effective 11/1/2023, will align managed care coverage so that populations remain enrolled with their health plan through transitions, including: 
  1. Newborns of CCC Plus Mothers will have birth month plus two coverage (will follow the existing Medallion process),
  2. Individuals transitioning into LTSS will no longer drop to FFS as they did under Medallion before enrolling with the same plan under CCC Plus. Members will remain enrolled with their MCO (will follow the existing CCC Plus process),
  3. Members who enroll in the MCO while in the hospital will remain in managed care (will follow the existing CCC Plus process). The DRG payment provisions remain unchanged as they are already fully aligned in CCC Plus and Medallion. 

*11/1 date enables advance notice of changes to providers who may be impacted. 
  • Members with significant health needs will continue to have access to comprehensive care management services through their health plan. 
  • Over the first few months, will implement a more responsive model of care, providing care management services across populations based on the member’s evolving needs and health risk
  • Same managed care enrollment broker to assist members with managed care selection process; allows access to consolidated site regardless of whether the member uses the CCC Plus or Medallion URL/phone number.  
  • New ID cards with the Cardinal Care brand/logo have been issued. 
  • Consolidated enrollment broker website and aligned regional open enrollment across all populations was effective 1/1/2023. 
  • MCOs – Same five health plans; members remain enrolled with their plan and can continue with current providers.
  • Increased efficiency. 

o    One CMS 1915(b) Waiver 
o    One MCO Contract with rates 

 

For context: DMAS was directed to merge the two managed care programs as part of the 2021 Appropriations Act.

  • DMAS proceeded with the initial phase to rebrand as Cardinal Care in January 2023, and has been working over the last year to obtain CMS approval of the consolidated managed care waiver.
Posted in DMAS, Managed Care, Medicaid
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