Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care Update Effective January 1, 2022
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The purpose of this bulletin is to inform providers of agency and consumer-directed personal care, respite and companion services in the Home and Community Based Services (HCBS) waivers and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) program that the temporary 12.5 percent HCBS rate increase described in the October 6, 2021 Medicaid bulletin shall become permanent effective January 1, 2022 in accordance with Item 313 #SSSS.3 of the 2021 Appropriations Act.
Per the October 6th bulletin, “Agency-directed and consumer-directed personal care, respite, and companion services will receive the temporary HCBS rate increase until December 31, 2021, at which time the permanent 12.5% rate increase will be implemented. This action is in accordance with the 2021 Appropriations Act as amended in the Virginia General Assembly Special Session II.” The rates for the temporary HCBS rate increase and the permanent increase remain the same for these services. Permanent personal care, respite, and companion service rates are in the following table:
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Agency Directed |
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Procedure Code |
Service Description |
Location |
Rates Effective 1/1/2022 |
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T1019 |
Personal Care |
NOVA |
$20.27 |
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T1019 |
Personal Care |
ROS |
$17.22 |
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T1005 |
Respite Care |
NOVA |
$20.27 |
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T1005 |
Respite Care |
ROS |
$17.22 |
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S5135 |
Companion Care |
NOVA |
$20.27 |
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S5135 |
Companion Care |
ROS |
$17.22 |
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Consumer Directed |
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Procedure Code |
Service Description |
Location |
Rates Effective 1/1/2022 |
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S5126 |
Personal Care |
NOVA |
$15.30 |
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S5126 |
Personal Care |
ROS |
$11.81 |
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S5150 |
Respite Care |
NOVA |
$15.30 |
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S5150 |
Respite Care |
ROS |
$11.81 |
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S5136 |
Companion Care |
NOVA |
$15.30 |
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S5136 |
Companion Care |
ROS |
$11.81 |
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Personal Care, Respite and Companion Care Rates Effective January 1, 2022
This bulletin serves as the official notification that personal care rates effective January 1, 2022 are posted on the DMAS website at https://www.dmas.virginia.gov/for-providers/long-term-care/waivers/. Corrections or revisions will be noted at the bottom of the official rate sheet. If you have any questions regarding personal care rates please contact the DMAS Helpline at 1-800-552-8627.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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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 |
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KEPRO Service authorization information for fee-for-service members.
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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. |
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), 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. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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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 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Molina Complete Care
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1-800-424-4524 (CCC+) 1-800-424-4518 (M4) |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |