Commonwealth Coordinated Care - Virginia

Program Location: 
Richmond, VA
Payer Type: 
Virginia Premier
Amerigroup (Healthkeepers)

CMS signed a Memorandum of Understanding with the state of Virginia on 5/21/2014. Commonwealth Coordinated Care is a new initiative to coordinate care for individuals who are currently served by both Medicare and Medicaid and meet certain eligibility requirements. The program is designed to be Virginia’s single program to coordinate delivery of primary, preventive, acute, behavioral, and long-term services and supports. In this way, the individual receives high quality, person centered care that is focused on their needs and preferences.

The goals of this initiative include: improved quality and health outcomes, streamlined Medicare and Medicaid requirements, increased accountability, reduced burden for enrollees and providers, providing care in each individual’s setting of choice, and reduced avoidable services. Supplementary benefits will include care coordination, interdisciplinary care teams, and person-centered care plans.

Payment Model: 

Medicare and Medicaid will each contribute to the total capitation payment consistent with baseline spending contributions; Demonstration savings percentages assume that ICOs are responsible for the full range of covered services under the Demonstration; Aggregate savings percentages will be applied equally to the Medicaid and Medicare A/B components; and Both CMS and MDCH will contribute to the methodologies used to develop their respective components of the overall blended rate. More information on the demonstration's payment model can be found in Appendix 6 of the approved contract with CMS. 

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