We have heard from many of you that you are receiving contracts or addendums to your CCC Plus contracts pertaining to the Medallion 4.0 program as the Department of Medical Assistance Services (DMAS) re-procured its Medallion 4.0 contract and selected the same six managed care organizations (MCOs) that participate in the CCC Plus program for statewide coverage.  While Medallion 4.0 does not have a long term care benefit, it is possible that a MCO could look to a nursing facility as a step-down or rehabilitation provider.

About Medallion 4.0

Medallion 4.0 is the updated version of the long-standing Medicaid managed care program for non-long term care recipients.  This program has been around in previous iterations since the mid-1990s in some regions of the Commonwealth, and has been statewide for several years now.  It has generally served children, pregnant women, and very low income caretaker adults. Medallion 4.0 does not have a long term care benefit.  Most, if not all, Medallion 4.0 recipients will not have Medicare.

Under the latest version of the Medallion contract, DMAS is phasing in regions similar to how they approached CCC Plus beginning August 1.

Considerations for Nursing Facilities

While Medallion 4.0 does not have a long term care benefit, it is possible that a MCO could look to a nursing facility as a step-down or rehabilitation provider.  Basically, Medicaid managed care programs have a bit more flexibility with “substitutable” services, like using a nursing facility for step-down as opposed to a hospital unit, potentially.  As such, you may want to discuss the contract or addendum with the MCO to determine its purpose for including your facility in the Medallion 4.0 network.  It is also likely, that since these six MCOs are now statewide with both Medicaid projects, they are simply seeking a uniform, consistent contract across all their Virginia products.  However, this may be an opportunity to discuss services you could provide (within your licenses) for the non-long term care population through Medallion 4.0.