By OPEN MINDS Circle
On August 31, 2023, the Virginia Department of Medical Assistance Services (DMAS) released a request for proposals (RFP 13330) for its new Cardinal Care Medicaid managed care (CCMC) program and new foster care specialty plan. The contracts are currently held by Aetna, Elevance/Anthem, Molina, Sentara Healthcare/Optima/Virginia Premier, and UnitedHealthcare. The plans serve more than 1.5 million managed care members statewide. Responses are due by October 27, 2023. The contracts are slated to go live on July 1, 2024.
The CCMC program launched on January 1, 2023, to combine Virginia’s two existing managed care programs – Medallion 4.0, which enrolled the general population; and Commonwealth Coordinated Care Plus (CCC Plus), which enrolled beneficiaries with behavioral health disorders and/or long-term care needs. The state’s goal was to create a single identity for all members receiving services through Medicaid managed care organizations (MCOs). The overarching brand and program alignment also includes fee-for-service Medicaid members, ensuring smoother transitions for individuals whose health care needs evolve over time.
Under the contracts to be awarded through the CCMC RFP, the managed care organizations (MCOs) will be responsible for providing all state plan Medicaid medical and behavioral health services, community mental health services, early intervention, prescription medication coverage, and long-term services and supports (LTSS). The LTSS includes nursing facility care and services through four of the five DMAS home- and community-based services (HCBS) 1915(c) waivers. The CCMC contractors will operate in all six regions of the state and in all localities in each region. The six regions are Central Region, Tidewater Region, Northern & Winchester Region, Charlottesville Western Region, Roanoke/Alleghany Region, and Southwest Region.
The state anticipates awarding up to five contracts, with one of the contractors being awarded the foster care specialty plan to serve youth in foster care, youth eligible for adoption assistance, and young adults formerly in foster care. The specialty plan will provide care and services targeted to meet the unique physical and behavioral health needs of this population. However, DMAS is still seeking federal approval for this approach. DMAS noted that if the Centers for Medicare & Medicaid Services (CMS) does not grant approval for a specialty plan, then the MCO contracts will be modified and the MCOs selected to serve the general population will be required to cover services for the specialty plan population.
For these upcoming contracts, DMAS is promoting five targeted focus areas for improvement. These include:
Improving behavioral health and population health outcomes: Within this focus area, DMAS is exploring the possibility of including youth residing in psychiatric residential treatment facilities (PRTF) into managed care, but carving out PRTF services. Currently children in a PRTF are excluded from managed care. DMAS intends to require the MCO strategic plans to address health related social needs (HRSNs) with an emphasis on housing stability and food access. DMAS will require the MCOs to follow-up with members within 24-hours after notification that a member has used crisis services.
Providing member-centered holistic care that meaningfully engages and addresses unique needs of all members: Within this focus area, the MCOs will be required to coordinate care for members and identify those potentially in need of care management through in-person and telephonic interventions. The MCOs will be required to establish an HRSN plan and develop a community assessment and member engagement approach to help members make informed decisions. The MCOs will also be required to use care management extenders, such as community health workers, in collaboration with care managers. DMAS will require the MCOs to support whole person care for dual eligible members. By January 1, 2025, all Medicare Advantage Special Needs Plans for Dual Eligibles (D-SNPs) will be required to meet additional requirements.
Enhancing availability and accessibility of care across all care settings: Within this focus area, the MCOs will need to meet more stringent provider organization network standards and take steps to reduce the administrative burden on provider organizations. The actions to reduce burden include using a standardized credentialing process, more specific MCO clean claim and prompt pay requirements, additional provider training, technical assistance, and data to targeted provider organizations.
Enabling participants receiving long-term services and supports (LTSS) to live in their setting of choice and promote their well-being and quality of life: Within this focus area, DMAS broadly intends that the MCOs will use a person-centered approach to member engagement and communications and adhere to requirements for provider organization availability to travel to members’ homes. DMAS seeks to ensure support for members with intellectual/developmental disabilities (I/DD) such that they receive coordinated services across managed care, home-and community-based services, and other Medicaid and non-Medicaid services, with the goal of improving overall health outcomes for the I/DD population.
Using new technologies, payment models, and best practices for accountability and impact: Within this focus area, DMAS intends to require the MCOs to better align quality measures in value-based payment arrangements with applicable MCO performance withhold measures and CMS core measure sets.
DMAS will use a numerical scoring system to evaluate the proposals. The highest possible score is 1,000 points. The proposal sections about the Foster Care Specialty Plan will be scored separately. The maximum number of points per section are as follows:
- 100 points for the offeror’s qualifications, experience, and expertise
- 200 points for the benefits and service delivery
- 150 points for population health and member-centric care strategies
- 150 points for provider organization network development and administration
- 100 points for quality and value based payments
- 100 points for information systems
- 200 points for the oral presentation