September 06, 2013
COMMONWEALTH COORDINATED CARE PROGRAM
For some providers of behavioral health services there will be a second, and potentially more dramatic, shift in the way they do business, how they are paid and what they are paid for a targeted group of clients in Central Virginia & Tidewater (northern Virginia & western Virginia will come into the program later in 2014) beginning as early as March 1st of 2014. We have been meeting with DMAS and reps of the VACSB to get relevant information and guidance to share.
First – each provider of behavioral health services for adults (21 and older) should carefully review the information available on the project at the website below:
Second – each provider should determine if they provide, or wish to provide, outpatient mental health services or community mental health rehabilitative services to adults (21 and older) who are full
Medicaid and Medicare eligible.
Third – each provider that wishes to provide services to the population described should contact the three health plans that are currently in negotiation to manage the integrated Medicaid/Medicare care for the targeted population:
Lindsay Berry, VP Government Relations
Neil Steffens, Market VP,Virginia
Jill Sumner, VP Strategic Planning & Business Development
As the plans select their panel of providers, providers should expect a credentialing process that meets NCQA standards, and a contract negotiation with each health plan.
All aspects of service provision, authorization and claims payment will be the responsibility of the health plans within the guidance provided in the contracts currently being reviewed by DMAS. The plans have already negotiated contracts with the CSBs and there is discussion underway to offer an option for the CSBs to be the “health home” for persons who are in need of behavioral health services. We know, however, that the CSBs are not in a position to provide all of the needed services, so there will be a viable role for the private sector.
There are many details available about enrollment for consumers, education for CMs who will assist consumers whose BH services will now be coordinated, authorized and reimbursed by Magellan for a December implementation date and then, in Central Virginia & Tidewater, those adults who are duals eligible and not in an otherwise exempt group will be offered an entirely different set of options beginning February 1, 2014. There is bound to be a fair amount of confusion for all parties.
We will have the opportunity to talk about this further at the VNPP Fall Conference, but it is important that in addition to becoming a credentialed Magellan provider you make the contacts suggested above to position your company to be selected for the panel of providers for the demonstration project.