Coverage of Substance Use Disorder (SUD) Treatment Services in Institutions for Mental Diseases (IMD) Settings for FAMIS MOMS Members
Download PDFThe purpose of this bulletin is to notify providers that, in accordance with Item 312.G of the 2021 Special Session I Appropriations Act, as of July 1, 2021, FAMIS MOMS enrollees will have access to medically necessary treatment for substance use disorder (SUD) in an Institution for Mental Diseases (IMD), equivalent to such benefits offered to pregnant women under the Medicaid state plan and Medicaid Section 1115 demonstration waiver.
This coverage includes the following settings: American Society of Addiction Medicine (ASAM) Levels 3.3, 3.5, and 3.7 in residential treatment settings, psychiatric units and free-standing psychiatric hospitals.
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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 |
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 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 |
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 |
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 |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |