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Developmental Disabilities (DD) Waiver Services and Home and Community Based Services (HCBS) Rate Updates – Effective July 1, 2022

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Bulletin
Effective Date:

To:
Providers of Home and Community Based Services Waivers (HCBS), Developmental Disabilities (DD) Waivers, Addition and Recovery Treatment Services, Community Mental Health Rehabilitation Services and Early Periodic Screening, and Diagnosis and Treatment
From:
Cheryl J. Roberts, Acting Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify providers of new rates effective July 1, 2022.

As stated in the June 28, 2022 bulletin on “Implementation of new rates from 2022 State Budget Appropriations,” DMAS is diligently working on the implementation of new rates set forth in the 2022 Appropriation Act approved by Governor Youngkin on June 22, 2022. The new fiscal year 2023 fee-for-service rates have been posted.. However, Managed Care Organizations (MCOs) are continuing to update their rate systems, so providers will need to work directly with their MCO partners to determine billing procedures. Providers will also need to work with DMAS’s Behavioral Health FFS Contractor (Magellan Behavioral Health) to determine billing procedures as well.

Rate Update for Developmental Disabilities Waiver Services

In accordance with the 2022 Appropriation Act Item 304.KKKK(2), the Department of Medical Assistance Services (DMAS) will update the DD Waivers services using the most recent data to be consistent with efficiency, economy, quality, and sufficiency of care. Rate increases shall be made for the following services: Group Homes, Sponsored Residential, Supported Living, Independent Living Supports, In-home Supports, Community Engagement, Community Coaching, Therapeutic Consultation, Private Duty and Skilled Nursing, Group Day Support, Group Supported Employment, Workplace Assistance, Community Guide, DD Case Management and Benefits Planning. DD Waiver rate updates can be found on the DMAS website at https://www.dmas.virginia.gov/for-providers/long-term-care/waivers/ under “Developmental Disabilities Waiver Rates.”

Please note, rebased DD Waiver rates will not be based on the temporarily increased rate referenced below but instead, DD Waiver services will receive rate adjustments as defined in budget item 304.KKKK using methodologies defined in the Burns and Associates rate study.

Temporary 12.5% HCBS Rate Update (American Rescue Plan Act (ARPA) of 2021)

DMAS released a Medicaid Bulletin on October 10, 2021 entitled “Temporary Home and Community Based Services (HCBS) rate update effective July 1, 2021” that provided information on the select HCBS services to receive a temporary 12.5% rate increase for dates of service on or after July 1, 2021 through June 30, 2022.  

Effective July 1, 2022, a specific set of HCBS services from the services named in the October 10, 2021 Bulletin will retain that temporary 12.5% rate increase.  This revised set of services is pursuant to the 2022 Appropriation Act.  Services not described in this budget item are not eligible to retain the previously increased rates and will revert to their rates prior to July 1, 2021.

The following services will retain the 12.5% rate increase that began on July 1, 2021:

  • Adult Day Health Care
  • Consumer-Directed Service Facilitation services
  • Early Intervention Case Management
  • Intellectual Disability Case Management
  • DD Waiver Crisis Supports (Center Based, Community Based and Crisis Support Services)
  • ASAM Level 3.1 Low Intensity Residential
  • Mental Health Case Management 
  • Community Mental Health Rehabilitation Services (Intensive In Home, Therapeutic Day Treatment, Mental Health Skill Building, Psychosocial Rehabilitation, CMHRS Assessments)
  • Mental Health Therapeutic Group Home
  • BRAVO Crisis Services (Mobile Crisis Response, Community Stabilization, 23 Hour Crisis Stabilization, Residential Crisis Stabilization, Psychotherapy for Crisis CPT codes)
  • Other BRAVO Services: Multi-systemic Therapy (MST), Functional Family Therapy (FFT), Applied Behavior Analysis (ABA), Assertive Community Treatment (ACT), Mental Health Intensive Outpatient (MH IOP) and MH Partial Hospitalization Program (MH PHP) Services

A list of eligible procedure and revenue codes along with the code description for the rate increase appears in the table below.

Please note the following services will not retain the 12.5% rate increase:

  • Early Intervention services with the exception of Early Intervention (EI) case management,
  • Home Health and Center Based Rehabilitation Services.  
  • Personal Care, Companion and Respite Services
  • Peer Recovery Support Services for both mental health and substance use disorder services The rates for these services were increased effective July 1, 2022, in accordance with the 2022 Appropriation Act, Item 304.QQQQ.
  • ARTS services consisting of Office Based Addictions Treatment, Intensive Outpatient, Partial Hospitalization, OBAT and OTP related services
  • Additional reimbursement rate detail can be found on the DMAS Website as indicated on page 12 of this document. 

A list of eligible procedure codes for the 12.5% rate increase appears in the tables below.

Behavioral Health Services Procedure Codes Retaining the ARPA Rate Increase 7/1/2022*

90839

97158

H2012

90840

0362T

H2016

97151

0373T

H2018

97152

H0031

H0032

97153

H0035

H2033

97154

H0036

H2034

97155

H0040

S9480

97156

H0046

S9482

97157

H2011

S9485

H0040

H0046

H2017

H2020

H0023

T1016

 

All Other Procedure Codes Retaining the ARPA Rate Increase 7/1/2022*

T1017

 T2022

T2034

H2019

 S9484

H2000

S5102

S5109

S5116

T1028

99509

 

*HCBS services and rates are subject to claims payment processing procedures which may result in different reimbursement according to billing practices and program participation. All claims are subject to post payment review.

Payment System Updates, Provider Billing, Web Updates, Etc.

Payment System Updates: HCBS rate updates described in this bulletin were updated in the DMAS payment system on July 19, 2022. MCOs will update their payment system on or after August 19, 2022.  MCO providers have two choices: 1) they may bill now and have claims reprocessed after MCO system adjustments are completed for these changes or 2) they may wait for the claims system updates to be implemented by the MCOs before billing any codes that were subject to the changes described in this memo. All MCOs will reprocess any claim paid at the lower rate by September 19, 2022.

Fee for Service Provider Billing: Providers may choose to bill DMAS prior to the rate update or wait until the payment system is updated. DMAS will not reprocess claims initiated prior to the rate changes being made in the payment system.

MCO Provider Billing:  All MCOs will be processing new rates on or after August 19, 2022.  For the services subject to rate increases all previously paid claims for dates of service July 1-August 19, 2022 will be reprocessed.  All MCO’s will have rates loaded to their websites and claims systems will be ready to process claims by August 19, 2022.

Web Postings: HCBS rate updates were posted to the DMAS website on July 15, 2022.

HCBS Rate Increase Resources

HCBS rates are published at the following locations:

Service rates that are not published under a specific program or waiver rate sheet can be checked by using our code search webpage at https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/procedure-fee-files-cpt-codes/  Procedure codes that start with a number can use our “Search CPT codes” function. Procedure codes that start with a letter need to be searched manually in our “HCPC Codes” file.

 

Please use the contact information listed below if you have any questions or concerns.

Fee-for-Service Claims

Virginia Medicaid Provider Helpline

Phone (Toll Free) - 800-552-8627

Phone (In State) -   804-786-6273

 

MCO Claims: 

CCC Plus

DMAS Website

MCO Directories by Region

(Claims Contact)

 

https://dmas.virginia.gov/for-providers/managed-care/ccc-plus/provider-resources/

 

 

MCO Claims:

Medallion 4.0

Aetna

Claims Inquiry Claims Research (CICR) team

1-800-279-1878 

Select the appropriate prompt for all other Claims issues.

Anthem

Brandon Hutchins-757-272-2593

brandon.hutchins@anthem.com

Molina

DMAS Website

https://dmas.virginia.gov/for-providers/managed-care/ccc-plus/provider-resources/

Optima

Provider Services Department

https://www.optimahealth.com/providers/frequently-asked-questions

https://www.optimahealth.com/documents/provider-orientation/012-orientation-key-contacts.pdf   

United

Tamara (Tami) Sink

+1(952) 406-5037

va_hcbs_pr@uhc.com

Virginia Premier

Claims Customer Service

Main Toll-Free Number: 877-719-7358

Escalation: Contact your dedicated Provider Relations Representative or email the complete detail to contactmyrep@virginiapremier.com

 

Additional MCO and BHSA Provider Claims Processing Resources:

Aetna https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/virginia/provider/pdf/provider_ manual_2021.pdf

Anthem

https://providernews.anthem.com/virginia/article/essential-information-you-need-to-submit-edicorrected-claims-3

Molina

https://www.molinahealthcare.com/providers/va/medicaid/resources/provider-materials.aspx

Optima

https://www.optimahealth.com/documents/provider-orientation/003-job-aid-view-claim-statussubmit-reconsideration-online.pdf 

United Healthcare

UHCprovider.com Home | UHCprovider.com 

Virginia Premier

https://www.virginiapremier.com/wp-content/uploads/ProviderCorrectedClaimUpdate.pdf 

BHSA-Magellan of Virginia

www.MagellanHealth.com/Provider

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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.

https://vamedicaid.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 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.

https://www.dmas.virginia.gov/appeals/

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

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

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

Molina Complete Care

 

1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

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