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Department of Behavioral Health and Developmental Services (DBHDS) Amendments to 12VAC35-105 and 12VAC35-46 for Behavioral Health Enhancement and American Society of Addiction Medicine (ASAM) Levels of Care Criteria – Service Modifications Processing Star

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Effective Date:

All Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

This bulletin is to alert providers of Addiction and Recovery Treatment Services (ARTS) and the following three Behavioral Health Services: Assertive Community Treatment (ACT), Mental Health Intensive Outpatient (MH-IOP), and Mental Health Partial Hospitalization (MH-PHP), that DBHDS will start processing Service Modifications on April 12, 2021.  DBHDS posted a memorandum to provide additional information regarding these service modifications to meet the three emergency regulatory actions, effective February 20, 2021.  These regulations are currently effective; however, the DBHDS Office of Licensing delayed implementation and enforcement of the emergency actions until July 1, 2021. 

The DBHDS memorandum is posted here:  The memorandum includes links to the service modifications and processes required to submit these to DBHDS.  This memorandum, the “Abbreviated Service Modification Form,” and the “Policy and Procedure Attestation Form” are located under “Behavioral Health Enhancement and ASAM” here:  Note that on April 20, 2021, DBHDS posted an updated version of the abbreviated service modification form for providers transitioning from their current license, to the corresponding ASAM Level of Care license, and for providers of ICT/PACT who will be transitioning to an ACT Team license. The abbreviated service modification form located here, has been updated based on feedback received following the original publication of the abbreviated form and to assist the MCO's in processing the new licenses.

Please note that per the DBHDS April 5, 2021 memorandum, the service modifications along with the relevant attachments need to be submitted to DBHDS as soon as possible, but no later than May 15, 2021, in order to ensure the new service license(s) will be effective by July 1, 2021.  Service modifications must be fully completed for DBHDS to process.  This includes checking off the license(s) that will be closing and checking off the new license(s) providers are applying for.  Please note that the DBHDS Office of Licensing cannot guarantee that modification forms received after May 15, 2021, will be processed prior to July 1, 2021.  Providers who do not have this conditional license issued by July 1, 2021, will not meet the DMAS requirements for reimbursement. (See 12 VAC 30-60-5 H 1.)  Providers must have these conditional licenses to meet the licensing requirements for Medicaid reimbursement.

Upon receipt of their conditional license, providers should submit these licenses to the relevant Medicaid Managed Care Organizations (MCOs) and Magellan of Virginia.

Contact Information for the Network Relations Teams are located here:

The DBHDS Office of Licensing conducted trainings related to the amendments to align the Children’s Residential Regulations with ASAM criteria and the amendments to align the Licensing Regulations (12VAC35-105) with ASAM criteria.  The training slide deck will be posted online at: under ”Behavioral Health Enhancement and ASAM” and is also located here.

DMAS is developing training sessions on the three Behavioral Health Enhancement services going live July 1, 2021.  These sessions will review the new services including provider requirements, covered services, documentation, and billing requirements.  The sessions will be recorded and available on the DMAS Behavioral Health Enhancement website located here.  Additional information concerning how to access the training sessions will be released at a later date.

Save the Dates for DMAS Provider Trainings:

  • Virtual Training Session #1: Intensive Outpatient and Partial Hospitalization Programs   May 18, 2021 @ 2-4pm
  • Virtual Training Session #2: Assertive Community Treatment  May 25, 2021 @ 10-12pm

Additional Questions

For additional questions related to the amendments to align the Children’s Residential Regulations with ASAM criteria and the amendments to align the Licensing Regulations with ASAM criteria, please contact Susan Puglisi at

For questions related to the amendments to align with enhanced behavioral health services, please contact Emily Bowles at

For general questions related to Behavioral Health Enhancement or substance use disorder treatment services, please contact the Behavioral Health Divisions at DBHDS or DMAS at the following emails:



Additional information related to BHE implementation can be found on the DMAS website here: The DMAS policy manual related to BHE is forthcoming and will be posted for public comment on the Regulatory Town Hall here:

For general questions relating to the service modification process, please reach out directly to your assigned licensing specialist.



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


Service authorization information for fee-for-service members.


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.

Medallion 4.0

CCC Plus


Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

For credentialing and behavioral health service information, visit:, email:,or

Call: 1-800-424-4046


Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.



Aetna Better Health of Virginia


Anthem HealthKeepers Plus


Magellan Complete Care of Virginia

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

Optima Family Care


United Healthcare


1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711),