DMAS Announcement today about replacement for CCC in Virginia

From DMAS Director April 4, 2016

DMAS Stakeholders:

This notice is to provide stakeholders with important updates on the Department of Medical Assistance Services' (DMAS) managed care program initiatives. These changes are consistent with General Assembly directives to add more populations and services into managed care and to strengthen the managed care programs.

The lessons learned from our Commonwealth Coordinated Care (CCC) program and the development of the Medicaid Managed Long Term Services and Supports (MLTSS) program has provided DMAS with the unique opportunity to reevaluate our managed care programs and design them in a manner that best serves Medicaid and FAMIS populations. For this reason, Medallion 3.0 and FAMIS will be restructured to serve pregnant women, families and children, and MLTSS will serve aged, blind, and disabled (ABD) populations. (The Program of All Inclusive Care for the Elderly, or PACE. will continue to be an integrated managed long-term care option for qualifying individuals.)

This strategy will allow for improved continuity of care and help to mitigate serve gaps, especially during transitions into complex community or institutional long-term care settings. DMAS will work with members, providers, health plans, and other interested stakeholders to provide outreach and education about these managed care initiatives. High level information by program is provided below. DMAS will provide additional details as available on the DMAS website.

Medallion 3.0 Procurement

DMAS will restructure and re-procure the Medallion 3.0 program, which currently serves more than 700,000 individuals.  Medallion 3.0 will serve adults and children in the low income families with children (LIFC), FAMIS, FAMIS MOMS and pregnant women covered groups. Individuals receiving LTSS who are enrolled in Medallion 3.0 for their acute and primary care services (known as the HAP population) and Medallion 3.0 ABD individuals will transition to MLTSS. The HAP population will transition to MLTSS during the MLTSS regional launch with the fee-for-service LTSS populations. The Medallion 3.0 ABDs without LTSS will transition to MLTSS in January 2018. Following the transition of HAP and ABD members to MLTSS, Medallion 3.0 will continue to serve over 665,000 Medicaid and 56,000 FAMIS members. The

Medallion 3.0 request for proposals (RFP) will be developed over the next several months and be released  later this calendar year  with an anticipated  implementation  date of Januaryl ,  2018.

Additional' information will be made available on the DMAS Medallion 3.0 webpage at: http://www.dmas.virginia.gov/Content     pgs/mc-home.aspx .

Managed  Long-Term  Services  and Supports Procurement

DMAS will revise the MLTSS design to include all aged, blind, and disabled (ABD) populations,  including  duals and LTSS populations.

•    PACE will continue to remain an integrated managed care option for all qualifying individuals.

•    The MLTSS RFP is scheduled to be released in April 2016. MLTSS will launch in the Spring of 2017, in regional phases, with full implementation  by January  1, 2018. The   HAP population  will transition  from Medallion  3.0 to MLTSS  during the MLTSS regional launch with the fee-for-service LTSS populations. The ABD population without LTSS currently  served under Medallion  3.0 will transition to MLTSS  in January of   2018.

•    The CCC population will transition into MLTSS at the end of the CCC demonstration (12/31/2017) in January, 2018. Additional information is available on the DMAS MLTSS webpage  at:   http://www.dmas.virginia.gov/Content    pgs/mltss-home.aspx .

DMAS  appreciates  your ongoing  support and cooperation  and we continue to look to each of  you, as our trusted stakeholders and partners, as we endeavor to design, develop, and implement initiatives and programs to better serve the citizens of the Commonwealth. We will continue to provide additional details on these initiatives to keep you fully informed and engaged. Questions related  to the MLTSS  program  may  be  sent to VAMLTSS@dmas.virginia.gov  .  Questions related  to Medallion  3.0 may  be  sent to ManagedCareHelp@dmas.virginia.gov .