Medical Society of Virginia

Virginia dual eligibles closer to coordinated care

22 July 2013

The Virginia Health Reform Initiative (VHRI) advisory council met on June 12 to discuss Medicaid reforms. Among the many topics that were discussed was the progress on creating a coordinated delivery system for “dual eligibles”—individuals who are eligible for both Medicare and Medicaid programs. Dual eligibles have some of the most complex health care needs, including chronic conditions, behavioral health needs and disabling conditions, expending about 41 percent of the Medicaid budget.

The Centers for Medicare and Medicaid Coordination Office (CMMCO) approved the Virginia Department of Medical Assistance Services’s (DMAS) plans to implement a three-year project to enroll dual eligibles into managed care organizations that provide all Medicare and Medicaid benefits and services. The goals of this demonstration include:

  • improved quality and health outcomes,
  • streamlined Medicare and Medicaid requirements,
  • increased accountability,
  • reduced burden for enrollees and providers,
  • care in each individual’s setting of choice, and
  • reduced avoidable services.

The new program, Commonwealth Coordinated Care, will have a coordinated delivery system for dual eligibles implemented in Virginia by Jan. 1, 2014. The approved proposal includes information on enrollment, network adequacy, appeals and quality for about 78,600 individuals who would qualify as dual eligible in Virginia.

Eligible individuals will be identified and will be sent enrollment information between Oct. 15 and Dec. 7 this year. Enrollment will be conducted in phases in the different regions in 2014. Throughout implementation, DMAS will work on education and outreach efforts, including stakeholder engagement, Web site updates, training to providers and local agencies, educational materials, education to community partners and strategic partnerships.

The Medical Society of Virginia (MSV) is supportive of the commonwealth’s work to coordinate care for dual eligibles and is ready to assist in evaluating different approaches to reimbursement design. MSV has asked DMAS to offer opportunities for providers to weigh in on plan design and to regularly communicate updates about the program.

Click here for additional information on the dual eligibles demonstration.

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