Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care Update Effective May 1, 2021
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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 |
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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 |
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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. | |
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.
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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
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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 feefor-service individuals. | |
Medallion 4.0 | |
CCC Plus | |
PACE | |
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 | 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 |