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Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care Update Effective May 1, 2021

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Bulletin
Effective Date:

To:
Providers of Home and Community Based Services Waivers (HCBS) and Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) services, Program of All Inclusive Care for the Elderly (PACE), participating in Virginia Medical Assistance Programs and Med
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to inform providers that  in accordance with Item 313 #SSSS.2 of the 2021 Virginia Acts of Assembly, rates for Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care rates will increase by 6.4%, effective May 1, 2021. The new rates for the services are indicated in the tables below.

Agency Directed

 

 

Procedure Code

Service Description

Location

Rates Effective 05/01/2021

T1019

Personal Care

NOVA

$18.02

T1019

Personal Care

ROS

$15.31

T1005

Respite Care

NOVA

$18.02

T1005

Respite Care

ROS

$15.31

S5135

Companion Care

NOVA

$18.02

S5135

Companion Care

ROS

$15.31

                                                  

Consumer Directed

 

 

Procedure Code

Service Description

Location

Rates Effective 05/01/2021

S5126

Personal Care

NOVA

$13.60

S5126

Personal Care

ROS

$10.50

S5150

Respite Care

NOVA

$13.60

S5150

Respite Care

ROS

$10.50

S5136

Companion Care

NOVA

$13.60

S5136

Companion Care

ROS

$10.50

Personal Care Rates Effective May 1, 2021 

The rates effective May 1, 2021 are posted on the DMAS website at http://www.dmas.virginia.gov/#/longtermwaivers. 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 Sara Benoit at Sara.Benoit@dmas.virginia.gov or (804) 786-3673. ​​​​​​​

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PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal

Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

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

KEPRO

Service authorization information for fee-for-service members.

 

 

https://dmas.kepro.com/

 

Provider Appeals

DMAS is launching an appeal portal in late May 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.  

https://www.dmas.virginia.gov/#/appealsresources

 

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 feefor-service individuals.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

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

Medicaid Bulletin: Personal Care Rate Update Effective 

DATE: 4/29/2021 Page 3

 

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 

www.aetnabetterhealth.com/Virginia  1-800-279-1878 

Anthem HealthKeepers Plus 

www.anthem.com/vamedicaid  1-800-901-0020 

Magellan Complete Care of Virginia 

www.MCCofVA.com

 1-800-424-4518 (TTY 711) or 1-800-643-2273 

Optima Family Care 

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare 

www.uhccommunityplan.com/VA and www.myuhc.com/communityplan 1-844-752-9434, TTY 711

Virginia Premier 

1-800-727-7536 (TTY: 711), www.virginiapremier.com