Virginia Department of Medical Assistance Services Awards Kepro $113M Contract for Utilization Management, Behavioral Health Utilization, and Case Management Services
McLean, VA, April 26, 2023 – The Virginia Department of Medical Assistance Services (DMAS) has awarded Keystone Peer Review Organization, LLC (Kepro), a subsidiary of CNSI, a $113 million contract to oversee utilization management (UM), behavioral health utilization, and case management services for Virginians who access their healthcare through the commonwealth’s Cardinal Care Medicaid program. The contract provides a five-year base of work with five option years. The award builds on Kepro’s 16-year history providing UM services for DMAS on the company’s proprietary Atrezzo care management platform.
Under the terms of the contract, Kepro will manage service authorizations for all inpatient and outpatient medical and behavioral health services within Cardinal Care’s fee-for-service program, as well as service authorizations for Medicaid waivers, non-traditional level of care services, and specialty services. The new scope of work will encompass service authorizations of residential treatment for children and adults and for community mental health rehabilitation. It also includes the provision of call center services for providers and members, a behavioral health crisis line, and care coordination for medical and behavioral health services.
“We are grateful to the Department of Medical Assistance Services for recognizing our long-standing partnership providing high quality utilization management services and for extending this new opportunity to support its behavioral health services,” said Todd Stottlemyer, CEO. “The commonwealth has long prioritized timely access to quality behavioral health services for its residents, and we look forward to supporting this important work.”
“This award reflects the dedication and deep expertise of our clinicians who have been proudly representing the Virginia Medicaid program since 2006, and we are honored to continue serving its program beneficiaries,” Meghan Harris, President and Chief Operations Officer.
“Kepro has been an important partner in delivering utilization management services to fee-for-service Medicaid beneficiaries,” said Patricia Arevalo, Program Operations Division/Service Authorization Unit; Manager, Service Authorization, DMAS. “We look forward to continuing that relationship and upholding our commitment to provide equitable access to vital healthcare services for all Virginians.”
For the past three decades, Kepro has been a recognized leader in quality-driven care management services. Its UM and care management programs span 34 state Medicaid contracts, to include Medicaid behavioral health services in 14 states. Its Atrezzo platform integrates these essential care management features within a modular, configurable solution that enhances care team coordination to drive better care and improved outcomes.
In December 2022, Kepro, a technology-enabled clinical services company, was acquired by and merged with CNSI, a leading provider of innovative healthcare technology products and solutions. With a combined 60+ years of experience, our team of clinicians, technologists, and industry experts help government-sponsored healthcare agencies and payers expand healthcare access, enhance quality, improve health outcomes, and lower costs through the company’s technology-enabled clinical services and solutions. The company will rebrand in 2023 under a new name. Learn more at www.cns-inc.com | www.kepro.com.