2017 Session

Budget Amendments - SB900 (Committee Approved)

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Independent Review of CCC Plus Managed Care Program and Rates

Item 284 #3s

Item 284 #3s

First Year - FY2017 Second Year - FY2018
Health and Human Resources
Secretary of Health and Human Resources FY2017 $250,000 FY2018 $0 GF
FY2017 $250,000 FY2018 $0 NGF

Page 262, line 4, strike "$728,480" and insert "$1,228,480".

Page 264, after line 10, insert:

"F.1. Out of this appropriation, $250,000 the first year from the general fund shall be provided for the Joint Subcommittee to Respond to Federal Health Care Changes and for Health and Human Resources Oversight to procure a contractor to conduct an independent review and evaluation of the program design and rates for the Commonwealth Coordinated Care (CCC) Plus program. As part of this review the contractor shall consider best practices based on other states' experiences with implementing managed long-term services and supports (MLTSS) programs to evaluate the effectiveness of the CCC Plus program design. Furthermore, the contractor shall evaluate the rates developed for the program that shall include a determination of actuarial soundness as required by 42 CFR 438.6(c). The contractor shall review the rate setting methodologies, processes and data used in the rate development for the CCC Plus program and make a determination of their impact on the sustainability of the program in the short-term and an assessment of any potential for an increase in future rates that may result. The contractor shall also assess the feasibility of creating one combined Medicaid managed care program for all populations and services. The contractor shall report recommendations to the Chairman of the House Appropriations and Senate Finance committees by October 1, 2017.

2. The Department of Medical Assistance Services shall amend its contracts with managed care companies in the CCC Plus and Medallion programs such that the contracts shall expire on December 31, 2020."


(This amendment provides $250,000 from the general fund and $250,000 from nongeneral funds the first year to procure a contract to conduct an independent review of the program design and rates for the Commonwealth Coordinated Care (CCC) Plus program. The CCC Plus program, which is expected to begin August 1, 2017, expands Medicaid managed care to long-term care services. This new program will serve over 200,000 individuals at a projected cost of nearly $4.0 billion in state and federal funds per year. The importance of the program to the Commonwealth requires additional oversight. Therefore, an independent review of the program and its rates would provide verification the program design is appropriate to serve the needs of the individuals enrolled and rates are justified within the current funding level for Medicaid. In addition, the Department of Medical Assistance Services is directed to modify the contract expiration date for the managed care programs by the end of 2020 for consideration of combining CCC Plus with the state's other managed care program known as Medallion.)