Commonwealth Coordinated Care Plus Update Oct 2017

Commonwealth Coordinated Care Plus Update – Oct 2017 We are pleased to provide you with the following important updates on the Department’s CCC Plus program initiative. Background Beginning August 1, 2017, DMAS launched the CCC Plus Managed Care program in the Tidewater region for full Medicaid members who are either 65 or older, children or adults with disabilities, nursing facility residents, and those receiving services and supports through a home and community based waiver. As CCC Plus begins in other regions, Medicaid will mail an enrollment letter and program information to eligible members. The new CCC Plus program will provide medical, behavioral health, substance use disorder, and long term services and supports services– all under one program. The program includes the additional benefit of a care coordinator assigned to each member. Detailed information on CCC Plus populations, services, and regional implementation schedule is available on the CCC Plus webpage. Provider Networks All six health CCC Plus Managed Care Organizations (MCO) met network adequacy requirements for all localities in the Central and Tidewater regions. In the Charlottesville/Western:  Aetna, Anthem, Magellan, Optima and Virginia Premier, are approved to participate in all localities.  United is approved to participate in all localities except for Lynchburg and Campbell county. In the Roanoke/Alleghany and Southwest Regions:  Aetna, Anthem, Magellan, Optima, and Virginia Premier, are approved to participate in all localities.  United is approved to participate in all localities except for Lee, Scott, Wise, and Norton. Networks are currently being reviewed by DMAS for Northern/Winchester region. Health Plans continue to build their provider networks. Providers may contact Health Plan Provider Relations department to initiate a conversation about joining a network. See the Contracting and Credentialing Contact Information for the participating health plans. Before a provider establishes a contract with the health plan, credentialing is required. Credentialing can take from 90-120 days to complete. See Credentialing 101 for more detail. CCC Plus Health Plan Websites Aetna Better Health https://www.aetnabetterhealth.com/virginia Anthem HealthKeepers Plus https://mss.anthem.com/va/Pages/aboutus.aspx Magellan Complete Care of http://www.mccofva.com/ VA Optima Health Community https://www.optimahealth.com/communitycare/Pages/defaul Care t.aspx UnitedHealthcare Community http://www.uhccommunityplan.com/

1 Plan Virginia Premier Health Plan https://www.vapremier.com/

Enrollment as of 10/4/2017 CCC Plus Enrollment by Regions MCO Tidewater Central Charlottesville/Western Total

Aetna 2,793 3,815 2772 9,380 Anthem 5,221 6,119 3192 14,532 Magellan 2,471 2,634 2225 7,330 Optima 4,128 3,378 3025 10,531 United 2,018 2,468 1801 6,287 VA 2,807 3,842 3259 9,908 Premier Total 19,438 22,256 16274 57,968

Continuity of Care Prior to April 1, 2018 For the implementation of CCC Plus, including populations and services beginning on January 1, 2018 (CCC, Medallion 3.0 ABD, and Community Mental Health Rehabilitation Services), the continuity of care period is up to 90 days, until April 1, 2018. Health plans will pay a member’s existing Medicaid providers during the continuity of care period, even if the provider is not contracted with the health plan. In addition, the health plan will honor the service authorizations issued by DMAS or the DMAS Contractor for the length of the existing service authorization or ninety days (whichever is sooner). Beginning on April 1, 2018 Once CCC Plus is fully implemented, continuity of care provisions will be adjusted as described below. Continuity of care provisions will apply for members who transition to CCC Plus from fee-for-service or for members who transition between MCOs.

To ensure continuity of care and a smooth transition for all CCC Plus Members at all times, the CCC Plus MCOs will:

1) Maintain the Member’s current providers for up to 30 days, and 2) Honor service authorizations (SAs) issued prior to enrollment, including out of network providers, for up to 30 days or until the authorization expires, whichever comes first; and, 3) Extend this time frame as necessary to ensure continuity of care pending the provider’s contracting with the health plan or the member’s safe and effective transition to a qualified provider within the MCO’s provider network or as authorized by the MCO out- of-network.

Exceptions to these continuity of care provisions include the following circumstances: 1) The Member requests a change; 2) The provider chooses to discontinue providing services to a Member as currently allowed by Medicaid; 3) The MCO or DMAS identify provider performance issues that affect a Member’s health or welfare; or, 4) The provider is excluded under State or Federal exclusion requirements.

Please contact the health plan for assistance submitting claims as an out of network provider.

Medicare: Crossover Claims Medicaid patients will have a CCC Plus Health Plan to provide their Medicaid coverage. If a patient has Medicare and Medicaid, their existing Medicare benefit coverage and providers do not have to change. Patients can continue their current Medicare plan and see their current Medicare providers. CCC Plus Medicaid Health Plans will coordinate the benefits of their members. CCC Plus Medicaid Health Plans will pay up to the Medicaid allowable for the entire service for crossover claims for patients with both Medicare and Medicaid, even if the provider is out of network with the patient’s assigned CCC Plus Medicaid Health Plan. A provider cannot balance bill a member for the crossover claim. Please see the Medical Provider CCC Plus update for more information and how to submit claims as a non-participating provider. New Provider Resources DMAS developed several tools to assist providers with the transition to CCC Plus. Please visit the CCC Plus Stakeholder/Provider webpage to find:  Updated Charts by Provider Type on how to do business with the Health Plans  Nursing Facility Admission Form  DMAS 98R Home and Community Based Services Request Form  Updated Managed Care Organization Directory by Region  CCC Plus Provider Reference Guide Please visit the CCC Plus Member webpage for:  Managed Care Organization Member Services Contact Information  Transportation Contacts for Health Plans Medicaid Eligibility It is important for providers to verify a member’s Medicaid eligibility at each point of service. Verification of a member’s participation in CCC Plus can be done through the DMAS MediCall audio response system (1-800-884-9730 or 1-800-772-9996) or the DMAS web-based internet option, available on the Virginia Medicaid Web Portal, at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal. As members are assigned to a CCC Plus health plan, the status of the enrollment is reflected in the member eligibility information data available on the 21st of every month for the first of the following month. For example, Medicaid enrolled providers can see assignment information beginning on Oct 21 for individuals who have an Nov 1st start date in the Southwest Region.

3 Both options are available at no cost to the provider. The web-based, automated response system (ARS) limits the provider's verification submission to 10 members at a time. CCC Plus enrollment can also be verified through the member’s health plan. Once you have identified the CCC Plus health plan, please use the following Care Coordination Phone line to get in touch with a Member’s Care Coordinator. Care Coordination Aetna Anthem Magellan Optima UnitedHealthCare VA Premier 1-855-652-8249 1-855-323-4687 800-424-4524 757-552-8398 OR 877-843-4366 1-877-719-7358 press #1 and ask Press #4 Toll Free 866-546- select option for for CC. 7924 Care Management

CCC Plus Advisory Committee Meeting Please join us for a CCC Plus Advisory Committee meeting on Oct 16, 2017 from 1 – 3pm at The Department of Medical Assistance Services, 600 East Broad St. Richmond, VA. Please RSVP to [email protected] by Oct 10, 2017. Education and Outreach DMAS developed a fact sheet about CCC Plus and the Developmental Disabilities Waivers. The Northern Virginia/Winchester town halls take place Nov 13, 14 and 16. Registration links are available on the Provider Town Hall Schedule and the Member Town Hall Schedule. The CCC Plus Helpline (1-844-374-9159) and CCC Plus enrollment website (cccplusva.com) are great resources for members, families and advocates. Conference calls with Members are being held every Tuesday from Noon – 12:30 pm. Members can call in to have questions answered by DMAS staff. To dial in to these calls, dial 1-800-832-0736; press *1095279#; and, then follow the voice prompts.

If you have questions or concerns about CCC Plus, please email the CCC Plus inbox, [email protected] for assistance.