Behavioral Health Services Redesign Implementation Date Change
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The purpose of this bulletin is to provide an update on Virginia Medicaid’s redesign of Community Mental Health Rehabilitative Services (CMHRS) which was authorized by the General Assembly in 2024. The redesigned services were originally planned to start on July 1, 2026, however, the start date will be delayed due to changes proposed during the current General Assembly session. DMAS will communicate the new implementation date to providers in an upcoming bulletin as soon as possible following the conclusion of the state budget process. All current Medicaid CMHRS will remain in effect until the redesign services are implemented.
Additional Information
The redesign includes the retirement of four Medicaid CMHRS:
Intensive In-Home Services
Therapeutic Day Treatment
Mental Health Skill Building Services
Psychosocial Rehabilitation
The new services which will be implemented are:
Community Psychiatric Support and Treatment (CPST) – Adult, Community
Community Psychiatric Support and Treatment (CPST) – Youth, Community
Community Psychiatric Support and Treatment (CPST) – Youth, School Setting
Coordinated Specialty Care for First Episode Psychosis
Mental Health Clubhouse Services
A standardized assessment, The Virginia Comprehensive Assessment of Needs and Strengths (CANS Lifetime), and new Level of Need Model will also be implemented as part of redesign.
Additional details including draft manuals, presentations and a frequently asked questions (FAQ) document are located here. Information related to Department of Behavioral Health and Developmental Services (DBHDS) licensing will be communicated directly to current providers by DBHDS and will be posted here.
Providers can direct questions related to Behavioral Health Services Redesign to the DMAS Behavioral Health Division at enhancedbh@dmas.virginia.gov. In addition, DMAS hosts Provider Open Office Hours dedicated to Behavioral Health Services Redesign questions from providers twice a month. Information on accessing these office hours is located here.
To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions. Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.
Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | |
Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | 1-800-884-9730 or 1-800-772-9996 |
Provider Appeals DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal. | |
Managed Care Programs Cardinal Care Managed Care and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. | |
Cardinal Care Managed Care | https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-… |
PACE | |
Provider Enrollment | In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. | 1-804-786-6273 1-800-552-8627 |
Aetna Better Health of Virginia | https://www.aetnabetterhealth.com/virginia/providers/index.html 1-800-279-1878
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Anthem HealthKeepers Plus | 1-800-901-0020
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Humana Healthy Horizons Provider Services Call Center | 1-844-881-4482 (TTY: 711) |
Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
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United Healthcare | 1-844-284-0146
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Acentra Health Behavioral Health and Medical Service Authorizations | https://vamedicaid.dmas.virginia.gov/sa 1-804-622-8900 |
Dental Provider DentaQuest | 1-888-912-3456 |
Fee-for-Service (POS) Prime Therapeutics
| https://www.virginiamedicaidpharmacyservices.com/ 1-800-932-6648 |