Current Updates (as of 8/31/23)
Managed Long-Term Services and Supports
On August 31st, the Virginia Department of Medical Assistance Services (DMAS) released an RFP for Cardinal Care. Cardinal Care Managed Care will be a comprehensive managed care program serving all populations, including those who receive LTSS. DMAS anticipates it will establish contracts with up to five MCOs, all of which must operate a Dual-Eligible Special Needs Plan (DSNP). Proposals were due October 27, 2023 and the anticipated start date is July 1, 2024.
(Source: Virginia Department of Medical Assistance; 08-31-2023)
Past Updates
Medicare-Medicaid Integration
On July 7, 2021, CMS released a combined evaluation report for the Virginia Commonwealth Coordinated Care (CCC) demonstration. The demonstration began in April 2014 and ended on December 31, 2017. The report describes the implementation of CCC for the state’s dually eligible population as well as an analysis of the impact of the demonstration which include qualitative and quantitative data. Results from the report include findings on the integration of Medicare and Medicaid, enrollment, care management, beneficiary experience, and cost savings and service utilization.
(Source: Virginia Commonwealth Coordinated Care Evaluation Report; 7-7-2021)
State Demonstration to Integrate Care for Dual Eligible Individuals
Virginia’s duals demonstration proposes to cover full benefit Medicare-Medicaid enrollees (age 21 and older), older persons and persons with physical disabilities, nursing facility residents, and persons who receive services through the Elderly or Disabled with Consumer Direction (EDCD) Waiver. Persons with intellectual/developmental disabilities who are not in the EDCD Waiver are excluded from the program. Assisted living services, intellectual/developmental disability services, and PACE programs will be carved out. The state targeted January 2014 for initial implementation in four regions, utilizing voluntary enrollment with opt out. The demonstration will use a capitated-managed care model. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)
Demonstration Proposal
State Website on Duals Demonstration
On May 21, 2013, then-Governor Bob McDonnell announced that Virginia has signed a Memorandum of Understanding (MOU) with CMS to implement its Medicare-Medicaid Enrollee Financial Alignment Demonstration, aimed at coordinating care for more than 78,000 Virginians currently enrolled in Medicare and Medicaid. Under this initiative, branded as Commonwealth Coordinated Care, Virginia and CMS will enter into a contract with health plans for the delivery of coordinated services and supports to enrollees. Eligible individuals include older adults and individuals with disabilities, including those receiving long-term services and supports, and who live in designated regions around the Commonwealth. The regions include the areas surrounding: Central Virginia/Richmond, Charlottesville, Tidewater, Roanoke and Northern Virginia. (Source: Press Release, May 21, 2013) Memorandum of Understanding
On December 4, 2013, the state and CMS entered into a three-way contract with health plans for the delivery of coordinated services and supports to enrollees. (Source: NSCLC Dual Eligible State Profiles website, March 2014)
Three-Way Contract (12/4/2013)
In March 2014, Virginia began voluntary opt-in enrollment in Commonwealth Coordinated Care; and passive enrollment began May 1, 2014. Residents must be dual eligibles and at least 21 years old to participate in the demonstration. Residents can opt out or withdraw from the plan at any time. (Source: Newsleader.com website; HMA Weekly Roundup, 6/18/2014)
In August 2014, Virginia released a Commonwealth Coordinated Care Update. As of August 1, 2014, there were 11,176 Virginians enrolled in the CCC program. This includes 2,825 individuals who have opted in to the
CCC program across the five CCC regions. On September 1, 2014, approximately 13, 000 individuals are scheduled to auto-enroll in CCC in the Central Virginia area. (Source: State Medicaid website)
Commonwealth Coordinated Care Update (8/2014)
In September 2014, Virginia released a Commonwealth Coordinated Care Update. As of September 1, 2014, there were 20,824 Virginians enrolled in the CCC program. This includes 3,266 individuals who have opted into the CCC program across the five CCC regions. Approximately 10,000 individuals are scheduled to auto-enroll in CCC on October 1, 2014 in the Charlottesville and Roanoke regions. (Source: State Medicaid website)
Commonwealth Coordinated Care Update (9/2014)
Effective October 6, 2014, Virginia Premier CompleteCare – a health plan in the Commonwealth Coordinated Care (CCC) duals demonstration program - has entered into an agreement with Magellan Healthcare, Inc. to implement a behavioral health management program to promote quality improvement for services provided to Virginia Premier CompleteCare members. (Source: Virginia DMAS website; Virginia Premier CompleteCare website)
On May 17, 2015, the Daily Press Media Group reported that Virginia’s Commonwealth Coordinated Care (CCC) program, a pilot program to provide managed care for dual eligible Virginia residents, has experienced a larger than expected drop in enrollments, threatening the program’s projected $44 million in savings. More than 40 percent of the 66,000 residents eligible for CCC have opted out of the program. Virginia health officials expect the program to become mandatory in the next few years. (Source: dailypress.com, 5/17/2015)
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Virginia’s Demonstration Year 2 (Calendar Year 2016) for the Virginia Commonwealth Coordinated Care Demonstration included three plans. All Financial Alignment Demonstrations include a provision to ‘withhold’ a portion of the Medicare-Medicaid Plans’ capitation rate that can be recaptured if the MMPs meet quality measures. In 2016, none of the plans met 100% of the performance measures—with the plans averaging 58%-75%. The average percent of withholding “received” stayed constant at 67% between 2016 and 2015. Two plans received 75% and one plan received 50% of withheld funds in 2016. (Source: Virginia Medicare-Medicaid Plan Demo Year 2, and Virginia Year 1, 6-19-2018) CMS released a summary of quality withhold analyses of Virginia’s Medicare-Medicaid Plans (MMPs) for the second demonstration year (CY 2017) of the Financial Alignment Initiative (FAI), called Commonwealth Coordinated Care. A percentage of both state Medicaid and federal Medicare capitation rates are withheld from the MMPs to ensure quality for dually eligible individuals. MMPs can earn the withheld funds back if Federal, CMS Core, and state-specific quality withhold performance measures were met. MMPs in Virginia met 72 percent of overall measures, 78 percent of the federal measures, and 67 percent of the state’s specific measures. (Source: Virginia Medicare-Medicaid Plan Quality Withhold Analysis Results; 8-14-2019) |
Managed LTSS Program
On June 2, 2015, the Virginia Department of Medical Assistance Services (DMAS) announced its intention to move most of the state’s remaining Medicaid fee-for-service (FFS) population into managed care in 2016 and 2017, including: dual eligibles not enrolled in the Commonwealth Coordinated Care Program (CCC); and individuals receiving full Medicaid and LTSS through an institution or HCBS waiver. Individuals on ID, DD, and DS waivers will continue to receive HCBS through Medicaid FFS. (Source: DMAS, 6/2/2015)
DMAS Stakeholder Letter, link no longer available (5/18/15)
On October 5, 2015, the state of Virginia released a fact sheet regarding the state’s proposed MLTSS program. According to the fact sheet, populations that will be included in the Virginia MLTSS program are 50,000 dual eligibles who receive full Medicaid benefits, 20,000 non-dual eligibles that receive LTSS, and Commonwealth Coordinated Care (CCC)—the state’s dual eligible demonstration—participants when the demonstration ends in December 2017. Implementation will be phased starting in 2017. Individuals with intellectual/developmental disabilities will receive acute care through health plans, but will receive HCBS services through fee-for-service. The MLTSS program aims to improve quality, access and efficacy of LTSS delivery. (Source: Fact sheet, link no longer avaialble 10/5/2015)
Virginia’s Section 1115 demonstration waiver is currently posted for public review and comment through January 6, 2015. The waiver seeks to implement two programs, a Medicaid MLTSS program, and a Delivery System Reform Incentive Payment (DSRIP) initiative. If approved, the Section 1115 waiver would operate from January, 2017 through December, 2022. The proposed MLTSS program would be fully integrated, including physical, behavioral and substance use, as well as LTSS benefits. The MLTSS program will be statewide but executed at the regional level. The VA MLTSS program will incorporate three 1915(c) HCBS waivers: the Alzheimer’s waiver, the technology assisted waiver, and the elderly and disabled with consumer direction waiver. ID/DD individuals and day support waivers will not be included. The MLTSS program will mandatorily enroll an estimated 46,000 dual eligibles excluded from Commonwealth Coordinated Care (CCC), the state’s financial alignment demonstration; 18,000 members in nursing facilities; and 66,000 dual eligibles that have enrolled or opted out of CCC. VA plans to issue an RFP in the spring of 2016, and a phased implementation schedule commencing in January 2017. (Source: Public Comment Document; HMA Roundup 12/16/2015)
On January 19, 2016, the Virginia Department of Medical Assistance Services (DMAS) formally submitted its section 1115 demonstration waiver application to CMS. The purpose of the waiver is twofold: to implement Medicaid managed long-term services and supports (MLTSS), as well as a delivery system reform incentive (DSRIP) program. The MLTSS initiative aims to build upon the state's dual eligible demonstration, Commonwealth Coordinated Care (CCC). DMAS is looking for authority to mandate enrollment of eligible populations into MLTSS. In addition, two 1915(c) HCBS waiver populations will be enrolled into the program, the Elderly or Disabled with Consumer Direction (EDCD) and Technology Assisted Waiver (Tech), in order to streamline administration for the state. Virginia's MLTSS program will provide services across the continuum of care including physical, behavioral, HCBS as well as institutional services. DMAS estimates approximately 129,500 individuals will be eligible for MLTSS, which will be enrolled in phases from March 1, 2017, through January, 2018. (Source: VA 1115 Waiver Application 1/19/2016)
According to HMA Weekly Roundup, Virginia is set to reprocure its Medicaid managed care program, which is called Medallion 3.0, in 2016. Medallion 3.0 covers approximately 740,000 beneficiaries, including pregnant mothers, children, parents up to 52 percent of the FPL, waiver recipients needing acute care services, as well as the aged, blind, and disabled (ABD) population. As a component of the new procurement, however, the ABD population will be shifted into the state’s proposed MLTSS program. (Source: HMA Roundup 4/6/2016)
The Virginia Department of Medical Assistance Services (DMAS) released the request for proposals (RFP) for the state’s statewide managed long term services and supports (MLTSS) program, which will begin phased enrollment in the summer of 2017. In addition to covering members who are aged, blind, and disabled (ABD), the MLTSS initiative will eventually replace the state’s dual eligible demonstration, Commonwealth Coordinated Care (CCC), when it sunsets near the end of 2017. MLTSS MCOs will manage the following services: LTSS, primary, acute, behavioral, and care coordination. In addition, all MCOs will be required to operate a Dual-Eligible Special Needs Plan (D-SNP) within two years from when the contracts are awarded. Following a mandatory preproposal conference on May 10, 2016, proposals will be due by June 30, 2016, with notice of intent to award issued by December 9, 2016. (Source: HMA Weekly Roundup 5/4/2016; RFP 4/29/2016)
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The Virginia Department of Medical Assistance Services (DMAS) has announced the MCOs selected to manage the state’s MLTSS program, which include the following:
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In December, 2016, the Virginia Joint Legislative Audit & Review Commission (JLARC) released a report on managing spending in Virginia’s Medicaid program. The report notes that although per beneficiary spending remained mostly level over the 2011-2015 period, overall general fund expenditures have grown an average of 8.9 percent over the past 10 years. In fiscal year 2015, Virginia spent $2.35 billion on LTSS. JLARC offers a number of legislative and executive recommendations that pertain to LTSS in the state. Legislative recommendations include:
JLARC also recommends the following executive actions:
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