DMAS VALTC Update

VHCA (4/11/08)

Earlier this week, the Department of Medical Assistance Services (DMAS) announced a series of new documents outlining their plan to implement the Virginia Acute and Long Term Care Integration (VALTC) program.  According to DMAS, this managed care program is designed to improve the quality of life of seniors and individuals with disabilities by providing them with the resources to remain independent and reside in the setting of their choice for as long as possible.  VALTC will be initially implemented in the Tidewater area beginning in February 2009, followed by launches in Richmond in December 2009 and Northern Virginia and the rest of the state in 2010.

As previously communicated to all members, VHCA met in January 2008 with senior DMAS leadership to discuss our desire to eliminate as much of the risk as possible for claims and payments associated with services provided to Medicaid managed care beneficiaries.  These discussions focus solely on individuals who are admitted to nursing facilities with Medicaid benefits already established.  We believe that this component of a nursing facility’s Medicaid resident population is in the range of 15% to 20% on average.

According to DMAS leaders, Medicaid managed long term care will never be an issue for all other nursing facility residents who ultimately receive Medicaid benefits after being admitted as Medicare or private pay and typically go through the spend down process.  For as long as these individuals remain in the nursing facility, they will not be enrolled in managed care and will remain fee-for-service beneficiaries.

We have reached an understanding with DMAS related to claims submission and payment for residents who enter nursing facilities as participants of a Medicaid managed care plan.  We believe that the provisions outlined in the Statement of Understanding will eliminate the vast majority of the financial risk and concern that has been attributed to working with MCOs.  The key point of this Statement of Understanding is that claims submission and payment will continue to be made to and by DMAS, not the MCO.

The period of time that a resident will be subject to oversight by the MCO is 60 days.  This time period will commence upon admission regardless of primary payor status at admission.  Once the Medicaid managed care plan resident reaches the 61st day of care in a nursing facility, DMAS will automatically remove them from the managed care plan and enroll them as a traditional fee-for-service beneficiary.

Members are encouraged to review the latest DMAS documents outlining the VALTC implementation plans.  VHCA continues to closely monitor this initiative and will provide updates to members as details unfold.