RD567 - The Department of Medical Assistance Services’ Proposed Plan for Merging its Managed Care Programs – November 15, 2020

Executive Summary:

Should it be the desire of the General Assembly, DMAS would propose to merge the Commonwealth Coordinated Care Plus and Medallion 4.0 managed care programs on July 1, 2022. The following report details how DMAS would effectuate a single, streamlined managed care program that links seamlessly with its fee-for-service program, ensuring an efficient and well-coordinated Virginia Medicaid delivery system that provides high-quality, equitable care to our members and adds value for our providers and the Commonwealth. Specifically, the report includes the following sections:

• Section 1 provides relevant background information and an overview of the proposed plan, including its value proposition

• Section 2 provides a brief history of managed care in Virginia and an overview of the current Virginia Medicaid delivery system

• Section 3 outlines key components of streamlining and aligning the managed care contracts

• Section 4 details other proposed overarching programmatic improvements, including rebranding the program and streamlining benefits and managed care enrollment processes where feasible

• Section 5 outlines the federal and state authority changes needed to achieve a unified program

• Section 6 provides an overview of other work streams and changes that would be necessary for implementation, such as IT system changes and updates to member and provider communications