RD521 - Medicaid Managed Care Organization Reporting of Providers and Provider Terminations – September 23, 2021
The Virginia Department of Medical Assistance Services (DMAS) engaged Myers and Stauffer LC (Myers and Stauffer) to assist with the development and test work of the newly required annual reporting by managed care organizations (MCOs) with regard to providers and provider terminations for Medicaid Community Mental Health Rehabilitation Services (CMHRS) in accordance with HB1800, Item 313, E.9 for the period July 1, 2018 through June 30, 2020. The engagement is performed in accordance with the American Institute of Certified Public Accountants’ standards for consulting engagements.
House Bill 1800, Item 313, E.9 reads as follows: The Department of Medical Assistance Services shall modify its contracts with managed care organizations to require annual reporting with regard to Medicaid Community Mental Health Rehabilitation Services on: (i) the number of providers in their network and their geographic locations; (ii) the total number of provider terminations by year since fiscal year 2018 and the number terminated with and without cause; (iii) the localities the terminated providers served; and (iv) the number of Medicaid members the providers were serving prior to termination of their provider contract. The department shall modify its contracts with the managed care organizations to require compliance with these provisions, effective July 1, 2021, such that the first reporting of this information by the managed care organizations shall be submitted by September 1, 2021. The department shall report the data annually, not later than November 1, to the Joint Subcommittee for Health and Human Resources Oversight.
Community Mental Health Rehabilitation Services are described in the provider manual of the same title which was revised November 1, 2016 and May 14, 2019. The Addiction and Recovery Treatment Services (ARTS) program was implemented April 1, 2017 and certain services were carved out of CMHRS and into the ARTS program. CMHRS covered services for the period under review include:
• Intensive In-Home Services for Children and Adolescents
• Therapeutic Day Treatment for Children and Adolescents
• Community-Based Residential Services for Children and Adolescents under 21
• Therapeutic Behavioral Services
• Day Treatment/Partial Hospitalization
• Psychosocial Rehabilitation
• Crisis Intervention
• Intensive Community Treatment
• Crisis Stabilization
• Mental Health Skill-building Services
• Mental Health Case Management
• Treatment Foster Care – Case Management
The number of unique Medicaid members enrolled in an MCO and utilizing CMHRS during the reporting period was 105,149. This information was derived through encounter data for service codes specific to CMHRS and dates of service from July 1, 2018 through June 30, 2020.