The Impact of Ending the VICAP

August 17, 2016

The VICAP was created in 2011 as a temporary measure to better manage access to select Medicaid-funded community mental health services (i.e., intensive in-home, residential treatment, and mental health skill building) for children up to age 21.  Although it was initially expected that Magellan would assume the VICAP function when it assumed the BHSA role in late 2013, DMAS chose to continue the process with the CSBs to enable thorough evaluation of the need for and value of the VICAP.  DMAS has determined that the functions of medical necessity review, level of care assessment, and authorization of services, the role previously fulfilled by CSBs can now be fulfilled by Magellan within its existing process.  In lieu of a VICAP assessment, providers will document medical necessity for each individual in accordance with specific service definitions.

We have raised our concerns that with this change it will be critical that Magellan be able to assure that the functions currently performed by the CSBs through the VICAP process are adequately performed within the Magellan process.  We need to be able to hold them accountable so that any fluctuations in cost are demonstrated to be the result of creating better access for individuals in need of the service(s).

We continue to participate in conversations about building a more robust continuum of care and hope that the approximately $4.5M to be saved with the ending of the VICAP will become a resource for building the services system.