Commonwealth Coordinated Care Plus MCO Contract for Managed Long Term Services and Supports - July 1, 2020 - June 30, 2021

Sep 16, 2026

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Commonwealth Coordinated Care Plus (CCC Plus) Managed Long Term Services and Supports contract with the Virginia Department of Medical Assistance Services, covering the period July 1, 2020 through June 30, 2021. The table of contents outlines contractual scope, applicable laws, departmental meetings, readiness review, licensure, quality certification, NCQA accreditation, D-SNP planning, business associate and authorization requirements, confidentiality and ownership disclosure, compliance program expectations, enrollment and assignment responsibilities, and detailed benefits and service provisions including behavioral health, dental, EPSDT, emergency services, long-term supports, pharmacy, telemedicine, transportation, carved-out and substituted services, translation and interpreter services, and other specific populations.

LanguageEnglish

CategoryLetters

FormatPDF

Pages551

Reading Time3 h 13 min

AccessFree to download

SECTION 1.0 SCOPE OF CONTRACT

1.1 APPLICABLE LAWS, REGULATIONS, AND INTERPRETATIONS

1.2 COMMITMENT TO DEPARTMENT GOALS FOR DELIVERY SYSTEM REFORM AND PAYMENT TRANSFORMATION

1.3 DEPARTMENTAL MEETINGS

SECTION 2.0 REQUIREMENTS PRIOR TO OPERATIONS

2.1 ORGANIZATIONAL STRUCTURE

2.2 READINESS REVIEW

2.3 LICENSURE

2.4 CERTIFICATION OF QUALITY

2.5 NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) ACCREDITATION

2.6 DUAL ELIGIBLE SPECIAL NEEDS PLAN (D-SNP)

2.7 BUSINESS ASSOCIATE AGREEMENT (BAA)

2.8 AUTHORIZATION TO CONDUCT BUSINESS IN THE COMMONWEALTH

2.9 CONFIDENTIALITY STATUTORY REQUIREMENTS

2.10 DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST

2.11 PROHIBITED AFFILIATIONS WITH ENTITIES DEBARRED BY FEDERAL AGENCIES

2.12 EXCLUDED ENTITIES

2.13 CONTRACTOR COMPLIANCE PROGRAM

SECTION 3.0 ENROLLMENT AND ASSIGNMENT PROCESS

3.1 ELIGIBILITY AND ENROLLMENT RESPONSIBILITIES

3.2 CCC PLUS ENROLLMENT PROCESS

SECTION 4.0 BENEFITS AND SERVICE REQUIREMENTS

4.1 GENERAL BENEFITS PROVISIONS

4.2 BEHAVIORAL HEALTH SERVICES

4.3 DENTAL AND RELATED SERVICES

4.4 EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT (EPSDT)

4.5 EARLY INTERVENTION (EI)

4.6 EMERGENCY AND POST-STABILIZATION SERVICES

4.7 LONG TERM SERVICES AND SUPPORTS

4.8 PHARMACY SERVICES

4.9 TELEMEDICINE AND TELEHEALTH SERVICES

4.10 NON-EMERGENCY MEDICAL TRANSPORTATION SERVICES

4.11 CARVED OUT SERVICES

4.12 STATE PLAN SUBSTITUTED (IN LIEU OF) SERVICES

4.13 ENHANCED BENEFITS

4.14 SERVICES RELATED TO FEDERAL MORAL/RELIGIOUS OBJECTIONS

4.15 TRANSLATION & INTERPRETER SERVICES

4.16 MEDICAID WORKS

4.17 ACA MINIMUM ESSENTIAL BENEFITS FOR MEDICAID EXPANSION POPULATION

4.18 FOSTER CARE AND ADOPTION ASSISTANCE CHILDREN

COMMONWEALTH OF VIRGINIA DEPARTMENT OF MEDICAL ASSISTANCE SERVICES COMMONWEALTH COORDINATED CARE PLUS MCO CONTRACT FOR MANAGED LONG TERM SERVICES AND SUPPORTS July 1, 2020 - June 30, 2021 CCC Plus Contract Table of Contents SECTION 1.0 SCOPE OF CONTRACT ................................................................................................................. 9 1.1 APPLICABLE LAWS, REGULATIONS, AND INTERPRETATIONS ......................................................................9 1.2 COMMITMENT TO DEPARTMENT GOALS FOR DELIVERY SYSTEM REFORM AND PAYMENT TRANSFORMATION ................................................................................................................................................. 10 1.3 DEPARTMENTAL MEETINGS ..................................................................................................................... 10 SECTION 2.0 REQUIREMENTS PRIOR TO OPERATIONS .................................................................................. 11 2.1 ORGANIZATIONAL STRUCTURE ................................................................................................................. 11 2.2 READINESS REVIEW ..................................................................................................................................13 2.3 LICENSURE ................................................................................................................................................ 14 2.4 CERTIFICATION OF QUALITY ..................................................................................................................... 14 2.5 NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) ACCREDITATION .........................................15 2.6 DUAL ELIGIBLE SPECIAL NEEDS PLAN (D-SNP) .......................................................................................... 15 2.7 BUSINESS ASSOCIATE AGREEMENT (BAA) ................................................................................................ 16 2.8 AUTHORIZATION TO CONDUCT BUSINESS IN THE COMMONWEALTH .....................................................17 2.9 CONFIDENTIALITY STATUTORY REQUIREMENTS ...................................................................................... 17 2.10 DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST ...........................................................................18 2.11 PROHIBITED AFFILIATIONS WITH ENTITIES DEBARRED BY FEDERAL AGENCIES .......................................20 2.12 EXCLUDED ENTITIES ..................................................................................................................................21 2.13 CONTRACTOR COMPLIANCE PROGRAM ...................................................................................................21 SECTION 3.0 ENROLLMENT AND ASSIGNMENT PROCESS .............................................................................. 23 3.1 ELIGIBILITY AND ENROLLMENT RESPONSIBILITIES ...................................................................................23 3.2 CCC PLUS ENROLLMENT PROCESS ............................................................................................................26 SECTION 4.0 BENEFITS AND SERVICE REQUIREMENTS .................................................................................. 36 4.1 GENERAL BENEFITS PROVISIONS ..............................................................................................................36 4.2 BEHAVIORAL HEALTH SERVICES ................................................................................................................36 4.3 DENTAL AND RELATED SERVICES ..............................................................................................................50 4.4 EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT (EPSDT) ..........................................52 4.5 EARLY INTERVENTION (EI) ................................

FAQs

What is the contract time period for CCC Plus?

The CCC Plus contract period runs from July 1, 2020 to June 30, 2021.

What pre-operation requirements are specified before the contractor begins operations?

The contract table of contents includes readiness review, licensure, certification of quality, NCQA accreditation, D-SNP planning, a business associate agreement, authorization to conduct business in the Commonwealth, confidentiality requirements, ownership/control disclosure, prohibited affiliations, excluded entities, and a contractor compliance program.

Which benefit and service areas are covered in the CCC Plus model of care section?

The table of contents lists behavioral health, dental services, EPSDT, early intervention, emergency and post-stabilization services, long-term services and supports, pharmacy, telemedicine/telehealth, non-emergency medical transportation, carved-out and substituted services, enhanced benefits, translation and interpreter services, Medicaid Works, and specific foster care and adoption assistance populations.

Sep 16, 2026

Upload by Rizky