DMAS Clarifies VALTC Letter

VHCA (3/28/2008)

A March 21st letter sent to Medicaid providers by the Department of Medical Assistance Services (DMAS) announcing the start-up of the Virginia Acute and Long Term Care Integration (VALTC) program contains a statement which contradicts a provision in an earlier Statement of Understanding drafted between VHCA and the Department.  DMAS has indicated its desire to begin implementation of the VALTC program in early 2009 in designated Tidewater localities.

Specifically, the letter received by Medicaid nursing facility providers states that “In order to serve VALTC enrollees in the affected localities, you must be contracted with one or more of the MCOs that the Department selects.”  VHCA contacted senior DMAS management staff and has received written confirmation that the statement is incorrect with respect to nursing facility providers. 

Once the VALTC program is implemented, a Virginia Medicaid beneficiary enrolled in a VALTC managed care plan who is referred by the plan to a nursing facility, will remain a member of the plan for a period of 60 days.  Arrangements for nursing facility services between a managed care organization (MCO) and a Medicaid-participating nursing facility during this 60-day period will be based upon referral relationships.  DMAS will not require contractual agreements between nursing facilities and managed care organizations. 

If the beneficiary remains in the nursing facility upon completion of the 60-day period, the beneficiary will be automatically disenrolled from the plan and will begin receiving services under the traditional fee-for-service (FFS) program.  While the VALTC MCO will be responsible for the Medicaid related costs of nursing facility care during the initial 60-day period, payment for services will be made directly from DMAS in a manner that is identical to payment made under the FFS program, including the per diem payment amount. 

VHCA member facilities providing services to Medicaid beneficiaries are encouraged to read the Statement of Understanding.