Earlier this week the Department of Medical Assistance Services (DMAS) released a draft of the contract it will use with each of the managed care organizations (MCOs) looking to participate in the CCC Plus Medicaid managed care program.  The contract includes language whereby DMAS would blend capitation rates for CCC Plus participants in nursing centers with those enrolled through the Elderly and Disabled with Community Direction (EDCD) waiver.

The capitation rate is the payment DMAS makes to the MCO to cover their cost of care (the MCO payments to providers, plus their administrative costs).  By blending the EDCD population with the nursing center population under one capitation rate, it will be somewhere between the higher cost of care in a nursing center and the lower cost of the EDCD waiver.  Paying the MCO less than their cost of care for nursing center residents will potentially create financial pressure on the MCO to either transition individuals from nursing centers to the community or reduce the cost of services provided while a resident is in a nursing center.

VHCA-VCAL is very concerned about how this approach will affect nursing centers. As such, we are asking you to submit comments to DMAS opposing this change in the CCC Plus program design.  Send your comments to CCCPlus@DMAS.Virginia.gov.

DMAS has provided stakeholders the opportunity to submit public comment until Tuesday, December 20.  VHCA-VCAL is currently working through our committee structure to prepare comments on this issue and other aspects of the draft contract. However, given the significance of this blended rate issue, we believe it is important for DMAS to hear directly from the membership.  Please take the time to comment on this issue (and any other contract issue you see) by emailing the agency at CCCPlus@DMAS.Virginia.gov.

VHCA-VCAL members work hard through the care planning process for individuals receiving Medicaid long term services to ensure they are treated in the proper setting.  We fear the draft CCC Plus contact language provides a financial incentive around service authorization and placement of these individuals that could have unintended consequences given the higher acuity level of those currently receiving care in nursing centers.

It is important to note that over 60 percent of long term care services are already provided in the community, which represents a very successful rebalancing within the Commonwealth.  Furthermore, VHCA-VCAL remains committed to work with all providers along the continuum of care to ensure that anyone receiving services that can be successfully transitioned from a nursing center to a community will be.  With the majority of individuals receiving care in nursing centers going home after their care is complete, VHCA-VCAL members believe this collaborative process has been successful.