August 05, 2019
There are more stories than we can count, so let’s try to set the record straight:
- Yes, the MCOs are terminating some provider contracts for all or some services offered by a provider; they are doing this based upon a plan submitted to and approved by DMAS in accordance with their contract. As a high ranking official at DMAS explained this morning – “This is managed care being managed care!”
- No, there is no widespread plan to eliminate TDT as a service; yes, we continue to have significant issues with authorizations (more with some MCOs than others)
- Yes, we are reaching out to the school divisions to try to assess the impact on their operations and their students, and yes, if you feel that the termination of your contact in whole or in part by an MCO would have a negative impact on access to services, you should share the information, concern and justification with managedcarehelp@dmas.virginia.gov and copy VNPP at forum@vnppinc.org. (We want to thank Mike Carlin at VACBP for that contact information)
We will continue to work with DMAS on several important issues:
- Based on our information, we believe that more schools limit the number of TDT providers to a single provider than allow multiple providers. Assuming that is true, the children enrolled in the MCO that has terminated the provider’s contract must now either be served “out of network” or not served at all. We will work with DMAS to ensure that contract termination decisions are made based on clear and accurate data.
- We will also work on resolving the specific service authorization/denial questions; in order to do so efficiently, please be sure to have the details available including the date, approximate time, name of the MCO staff, etc but be careful to not include any PHI!
You should continue to work with your schools and families to ensure they have a clear understanding of the limitations of your capacity.