Virginia

The State of Virginia is undergoing significant reforms to their Medicaid program. As outlined by Secretary Hazel in April 2014, the 1st phase includes implementation of their dual eligibles program, the Commonwealth Coordinated Care Program. The second phase includes "Limited Provider Networks and Medical Homes." These will include creating an agreement with the federal government that allows for limited provider networks would afford Virginia’s MCO’s, health systems, and health care providers to create innovative models of comprehensive care specific to a region, chronic condition, or co-occurring medical situations that span across physical and mental health. While number of providers may be reduced with a limited network, qualifying beneficiaries could receive higher quality coordinated care through a limited network arrangement.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
AAMC Project CORE: Coordinating Optimal Referral Experiences - Virginia	Grant	California, Iowa, New Hampshire, Virginia, Wisconsin	CMS Health Care Innovation Award (Round 2)
Commonwealth Coordinated Care - Virginia	Medicare, Medicaid	Central and Northern Virginia, Tidewater, Charlottesville, Roanoke	CMS Dual Eligible Demonstration, Medicaid Section 1115 Waiver
Improving Health for At-Risk Rural Patients (IHARP)- Carilion New River Valley Medical Center	Grant	Southwest Virginia	CMS Health Care Innovation Award (Round 1)
PTN - HQI	Grant	Virginia, Maryland	Transforming Clinical Practices Initiative (TCPI)

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
CareFirst Patient-Centered Medical Home - Northern Virginia	Commercial	Northern Virginia
Cigna Collaborative Accountable Care (CAC) Program - Fairfax Family Practice	Commercial	Fairfax	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - Bon Secours Medical Group	Commercial	Richmond	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - Loudoun Medical Group	Commercial	Richmond	Cigna Collaborative Care Program
Enhanced Personal Health Care Program - Virginia	Commercial	Statewide	Anthem - Enhanced Personal Health Care
Humana medical home program - Bon Secours	Commercial	Richmond	Humana Medical Home Program
Humana medical home program - Carilion Clinic	Commercial	Roanoke	Humana Medical Home Program

State Legislation

Legislation	Status	Year
HB 30 - 2022 Budget Bill This bill required the state Department of Health and Human Resources to contract with the Virginia Center for Health Innovation for actions necessary to facilitate and continue the work of the Virginia Task Force on Primary Care. The purpose of the task force is to enhance the financing, quality and delivery of primary care in the Commonwealth.	Enacted	2022