The Joint Commission on Health Care held its final meeting of the year on December 6, taking action on recommendations from its two major staff studies of 2023 and approving study resolutions for 2024. As reported in County Connections, at meetings earlier this year the Commission considered recommendations from a study of team-based care and a study of obesity and eating disorders, soliciting public comments after staff’s initial briefing on each topic.
Members approved the following recommendations from the team-based care study:
- Direct the Department of Medical Assistance Services (DMAS) to establish a reimbursement rate for Collaborative Care Model Services, which embed behavioral health providers into primary care.
- Direct DMAS to establish a reimbursement rate for medication therapy management provided by pharmacists through telehealth.
- Request the Joint Legislative Audit and Review Commission (JLARC) to evaluate the value and impact of state-funded health care workforce scholarship and loan repayment programs.
- Provide funding for the Virginia Center for Health Innovation’s Virginia Task Force on Primary Care to expand programs that work to develop the core criteria and performance measures of a team-based approach for payment purposes by health plans.
- Provide support to primary care practices transitioning to team-based care through the Area Health Education Centers, which are managed by the Virginia Health Workforce Development Authority.
- Direct DMAS to develop a plan to participate in the Medicaid health home program, which provides an enhanced federal match for team-based care for Medicaid beneficiaries with chronic conditions.
Members approved the following recommendations from the study of obesity and eating disorders:
- Direct DMAS to develop a plan to incorporate the National Diabetes Prevention Program as a covered service within the Medicaid State Plan. This program, which was previously piloted in Virginia and demonstrated success, focuses on people who are at risk for type 2 diabetes and promotes lifestyle changes to delay or prevent disease.
- Request the Health Insurance Reform Commission and Bureau of Insurance to define nutritional counseling in the essential health benefits benchmark plan (a set of benefits that comprehensive individual and small group health insurance coverage must provide), to ensure consistency across plans.
- Request the Health Insurance Reform Commission and Bureau of Insurance to conduct assessments to include medical nutrition therapy, when medically necessary, in the essential health benefits benchmark plan (this benefit is currently required only for people with diabetes).
- Direct DMAS to remove service limits for medical nutrition therapy when treating qualifying or eligible medical conditions. Medicaid managed care organizations cover these services but impose annual limits.
- Request the Health Insurance Reform Commission and Bureau of Insurance to conduct assessments to include weight loss medication, when medically necessary, as determined by a healthcare provider, in the Essential Health Benefits benchmark plan.
- Request the Health Insurance Reform Commission and Bureau of Insurance to conduct assessments to include bariatric surgery, when medically necessary, as determined by a healthcare provider, in the Essential Health Benefits benchmark plan.
- Direct DMAS to conduct a rate study to develop reimbursement rates for residential, partial hospitalization, and intensive outpatient services for eating disorder treatment for adults over 21.
- Require all Medicaid managed care organizations and state-regulated health insurers to remove prior authorization requirements for coverage of eating disorder services in order to reduce administrative burdens and expand access to treatment.
Commission members also approved two studies for 2024: a review of the performance and impact of health care workforce programs, and a study of the impact of various models to extend health care to vulnerable populations, including community paramedicine, home visiting, mobile health clinics, telehealth, and the services of community health workers.
VACo Contact: Katie Boyle