Developmental Disabilities (DD) Waivers Rate Changes Effective January 1, 2021

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Bulletin

January 1, 2021, 12:00AM

To:

All Providers of Developmental Disabilities (DD) Waivers Services

From:

Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

This bulletin (which supersedes the bulletin dated December 16, 2020 entitled, “Developmental Disabilities (DD) Waivers Rate Changes Effective January 1, 2021”) is a REVISION to the previous bulletin.

The purpose of this bulletin is to inform providers that rates for group home, sponsored residential, and day support services will increase, effective January 1, 2021. Pursuant to 2020 Special Session I Amendments to the 2020 Appropriation Act, Item 313 DDDD(1), the Department of Medical Assistance Services (DMAS) in consultation with the Department of Behavioral Health and Developmental Services (DBHDS), will increase provider payment rates for services delivered through the Community Living, Family and Individual Support, and Building Independence Developmental Disability (DD) waivers. The rate increase shall be provided for the following services: Group Home, Sponsored Residential, and Group Day Support. The rate changes are shown in the tables below and will be posted on the DMAS website at: https://www.dmas.virginia.gov/#/waiverservices.

Sponsored Residential Services
Procedure Code	Code Description	Location	Rate Effective 1/1/2021
T2033	Tier 1	NOVA	$170.50
T2033	Tier 1	ROS	$139.59
T2033	Tier 2	NOVA	$235.47
T2033	Tier 2	ROS	$192.17
T2033	Tier 3	NOVA	$304.10
T2033	Tier 3	ROS	$247.58
T2033	Tier 4	NOVA	$395.38
T2033	Tier 4	ROS	$321.24

Group Home Services
Procedure Code	Code Description	Location	Rate Effective 1/1/2021
H2022	4 or Fewer Person Homes, Tier 1	NOVA	$255.47
H2022	4 or Fewer Person Homes, Tier 1	ROS	$215.27
H2022	4 or Fewer Person Homes, Tier 2	NOVA	$305.13
H2022	4 or Fewer Person Homes, Tier 2	ROS	$256.55
H2022	4 or Fewer Person Homes, Tier 3	NOVA	$336.63
H2022	4 or Fewer Person Homes, Tier 3	ROS	$282.74
H2022	4 or Fewer Person Homes, Tier 4	NOVA	$402.96
H2022	4 or Fewer Person Homes, Tier 4	ROS	$337.89
H2022	5 Person Homes, Tier 1	NOVA	$238.54
H2022	5 Person Homes, Tier 1	ROS	$200.78
H2022	5 Person Homes, Tier 2	NOVA	$268.19
H2022	5 Person Homes, Tier 2	ROS	$225.43
H2022	5 Person Homes, Tier 3	NOVA	$297.84
H2022	5 Person Homes, Tier 3	ROS	$250.08
H2022	5 Person Homes, Tier 4	NOVA	$351.21
H2022	5 Person Homes, Tier 4	ROS	$294.44
H2022	6 Person Homes, Tier 1	NOVA	$231.13
H2022	6 Person Homes, Tier 1	ROS	$194.62
H2022	6 Person Homes, Tier 2	NOVA	$257.07
H2022	6 Person Homes, Tier 2	ROS	$216.19
H2022	6 Person Homes, Tier 3	NOVA	$286.72
H2022	6 Person Homes, Tier 3	ROS	$240.84
H2022	6 Person Homes, Tier 4	NOVA	$341.94
H2022	6 Person Homes, Tier 4	ROS	$286.74
H2022	7 Person Homes, Tier 1	NOVA	$223.72
H2022	7 Person Homes, Tier 1	ROS	$188.45
H2022	7 Person Homes, Tier 2	NOVA	$245.95
H2022	7 Person Homes, Tier 2	ROS	$206.95
H2022	7 Person Homes, Tier 3	NOVA	$275.61
H2022	7 Person Homes, Tier 3	ROS	$231.58
H2022	7 Person Homes, Tier 4	NOVA	$332.67
H2022	7 Person Homes, Tier 4	ROS	$279.03
H2022	8 Person Homes, Tier 1	NOVA	$216.30
H2022	8 Person Homes, Tier 1	ROS	$182.30
H2022	8 Person Homes, Tier 2	NOVA	$234.84
H2022	8 Person Homes, Tier 2	ROS	$197.69
H2022	8 Person Homes, Tier 3	NOVA	$264.49
H2022	8 Person Homes, Tier 3	ROS	$222.34
H2022	8 Person Homes, Tier 4	NOVA	$323.41
H2022	8 Person Homes, Tier 4	ROS	$271.33
H2022	9 Person Homes, Tier 1	ROS	$176.13
H2022	9 Person Homes, Tier 3	ROS	$213.10
H2022	9 Person Homes, Tier 4	ROS	$263.63

Group Home Services (continued)
Procedure Code	Code Description	Location	Rate Effective 1/1/2021
H2022	10 Person Homes, Tier 1	ROS	$169.97
H2022	10 Person Homes, Tier 2	ROS	$179.21
H2022	10 Person Homes, Tier 3	ROS	$203.86
H2022	10 Person Homes, Tier 4	ROS	$255.94
H2022	12 Person Homes, Tier 1	ROS	$157.65
H2022	12 Person Homes, Tier 2	ROS	$160.73
H2022	12 Person Homes, Tier 3	ROS	$185.38
H2022	12 Person Homes, Tier 4	ROS	$240.53

Group Day Support Services
Procedure Code	Code Description	Location	Rate Effective 1/1/2021
97150	Tier 1	NOVA	$10.43
97150	Tier 1	ROS	$8.90
97150	Tier 2	NOVA	$13.84
97150	Tier 2	ROS	$11.75
97150	Tier 3	NOVA	$16.42
97150	Tier 3	ROS	$13.98
97150	Tier 4	NOVA	$21.56
97150	Tier 4	ROS	$18.33

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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/

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