The Central Region went live for coverage under Commonwealth Coordinated Care (CCC) Plus on September 1.  Next up will be the Western/Charlottesville Region on October 1.  With Tidewater and Central now live under CCC Plus, estimated enrollment in the program is already nearly double the total statewide enrollment in the Dual Demonstration (the CCC program).  This week we received an important update regarding the level of care determination for long term care coverage and the pre-admission screening process using the Uniform Assessment Instrument (UAI).

As part of VHCA-VCAL’s on-going efforts to keep you informed of the latest developments, we have updates on the following topics:

• Level of Care Determination – UAI Process
• CCC/CCC Plus Issue Log Reminder
• Updated VA Premier Quick Reference Guide

Level of Care Determination – UAI Process

As previously communicated, VHCA-VCAL was very concerned when the Department of Medical Assistance Services (DMAS) specified to the managed care organizations (MCOs) under CCC Plus that the absence of the UAI meant there would be no payment to providers for long-term care services, including nursing facility care.  VHCA-VCAL voiced concern that the current pre-admission screening process from hospital discharges was not working properly and that denial of payment to nursing facilities was not the way to “fix” that process. 

To the Department’s credit, it agreed to “grandfather” existing nursing facility residents (when CCC Plus goes live in the region) and to temporarily relax the payment link to the UAI for new admissions while a separate workgroup examines possible modifications to the screening process, including a streamlined UAI. 

In the meantime, DMAS asked VHCA-VCAL to develop a form for use by all six MCOs communicating the Level of Care (LOC) needs for nursing facility admissions from hospital discharges where the UAI is not yet available.  Remember: under CCC Plus, the MCOs are responsible for entering the LOC determination directly into the DMAS system, thus triggering long term care coverage; the nursing facility will no longer be required to submit the paper work to DMAS, but rather, the “Nursing Facility Admission” form will be provided to the relevant MCO for the MCO to enter the LOC. NOTE:  this new form is only acceptable for admissions from the hospital; DMAS has not relaxed the UAI requirement for admission from the community.

On September 6, DMAS has released a printable/fillable “Nursing Facility Admission” form. This one-page form and its accompanying worksheet contains basic information typically obtained upon admission to a nursing facility.  The form is to be faxed to the relevant MCO (fax numbers are provided on the form) along with the hospital discharge orders within five days of admission (admission day + 4)  if the UAI is not available upon admission to the nursing facility from a hospitalization.  

This form does not replace or modify the normal required assessment schedule.  Also to reiterate, this approach is likely to be temporary pending the outcome of the separate group examining the screening process as a whole.

In addition to the admission form, DMAS has updated the “grid” outlining consensus approaches specific to nursing facility care on its website.  Go to the CHARTS: HOW TO DO BUSINESS WITH EACH HEALTH PLAN BY PROVIDER webpage and click “Nursing Facility” to view the grid. This document contains information regarding authorizations, claims, etc. and may be of use to your staff going forward.

CCC/CCC Plus Issue Log

Please keep VHCA-VCAL staff informed of any implementation issues you encounter.  You can use the CCC / CCC Plus Issue Log to relay any issues or concerns you have.

Updated Virginia Premier Quick Reference Guide 

VA Premier has updated the Quick Reference Guide we shared last week to correct an error.  Click here to access the updated guide.