Developmental Disabilities (DD) Waivers Rate Changes Effective January 1, 2021
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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.
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Sponsored Residential Services |
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Procedure Code |
Code Description |
Location |
Rate Effective 1/1/2021 |
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T2033 |
Tier 1 |
NOVA |
$170.50 |
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T2033 |
Tier 1 |
ROS |
$139.59 |
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T2033 |
Tier 2 |
NOVA |
$235.47 |
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T2033 |
Tier 2 |
ROS |
$192.17 |
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T2033 |
Tier 3 |
NOVA |
$304.10 |
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T2033 |
Tier 3 |
ROS |
$247.58 |
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T2033 |
Tier 4 |
NOVA |
$395.38 |
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T2033 |
Tier 4 |
ROS |
$321.24 |
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Group Home Services |
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Procedure Code |
Code Description |
Location |
Rate Effective 1/1/2021 |
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H2022 |
4 or Fewer Person Homes, Tier 1 |
NOVA |
$255.47 |
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H2022 |
4 or Fewer Person Homes, Tier 1 |
ROS |
$215.27 |
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H2022 |
4 or Fewer Person Homes, Tier 2 |
NOVA |
$305.13 |
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H2022 |
4 or Fewer Person Homes, Tier 2 |
ROS |
$256.55 |
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H2022 |
4 or Fewer Person Homes, Tier 3 |
NOVA |
$336.63 |
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H2022 |
4 or Fewer Person Homes, Tier 3 |
ROS |
$282.74 |
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H2022 |
4 or Fewer Person Homes, Tier 4 |
NOVA |
$402.96 |
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H2022 |
4 or Fewer Person Homes, Tier 4 |
ROS |
$337.89 |
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H2022 |
5 Person Homes, Tier 1 |
NOVA |
$238.54 |
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H2022 |
5 Person Homes, Tier 1 |
ROS |
$200.78 |
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H2022 |
5 Person Homes, Tier 2 |
NOVA |
$268.19 |
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H2022 |
5 Person Homes, Tier 2 |
ROS |
$225.43 |
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H2022 |
5 Person Homes, Tier 3 |
NOVA |
$297.84 |
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H2022 |
5 Person Homes, Tier 3 |
ROS |
$250.08 |
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H2022 |
5 Person Homes, Tier 4 |
NOVA |
$351.21 |
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H2022 |
5 Person Homes, Tier 4 |
ROS |
$294.44 |
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H2022 |
6 Person Homes, Tier 1 |
NOVA |
$231.13 |
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H2022 |
6 Person Homes, Tier 1 |
ROS |
$194.62 |
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H2022 |
6 Person Homes, Tier 2 |
NOVA |
$257.07 |
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H2022 |
6 Person Homes, Tier 2 |
ROS |
$216.19 |
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H2022 |
6 Person Homes, Tier 3 |
NOVA |
$286.72 |
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H2022 |
6 Person Homes, Tier 3 |
ROS |
$240.84 |
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H2022 |
6 Person Homes, Tier 4 |
NOVA |
$341.94 |
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H2022 |
6 Person Homes, Tier 4 |
ROS |
$286.74 |
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H2022 |
7 Person Homes, Tier 1 |
NOVA |
$223.72 |
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H2022 |
7 Person Homes, Tier 1 |
ROS |
$188.45 |
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H2022 |
7 Person Homes, Tier 2 |
NOVA |
$245.95 |
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H2022 |
7 Person Homes, Tier 2 |
ROS |
$206.95 |
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H2022 |
7 Person Homes, Tier 3 |
NOVA |
$275.61 |
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H2022 |
7 Person Homes, Tier 3 |
ROS |
$231.58 |
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H2022 |
7 Person Homes, Tier 4 |
NOVA |
$332.67 |
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H2022 |
7 Person Homes, Tier 4 |
ROS |
$279.03 |
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H2022 |
8 Person Homes, Tier 1 |
NOVA |
$216.30 |
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H2022 |
8 Person Homes, Tier 1 |
ROS |
$182.30 |
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H2022 |
8 Person Homes, Tier 2 |
NOVA |
$234.84 |
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H2022 |
8 Person Homes, Tier 2 |
ROS |
$197.69 |
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H2022 |
8 Person Homes, Tier 3 |
NOVA |
$264.49 |
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H2022 |
8 Person Homes, Tier 3 |
ROS |
$222.34 |
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H2022 |
8 Person Homes, Tier 4 |
NOVA |
$323.41 |
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H2022 |
8 Person Homes, Tier 4 |
ROS |
$271.33 |
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H2022 |
9 Person Homes, Tier 1 |
ROS |
$176.13 |
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H2022 |
9 Person Homes, Tier 3 |
ROS |
$213.10 |
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H2022 |
9 Person Homes, Tier 4 |
ROS |
$263.63 |
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Group Home Services (continued) |
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Procedure Code |
Code Description |
Location |
Rate Effective 1/1/2021 |
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H2022 |
10 Person Homes, Tier 1 |
ROS |
$169.97 |
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H2022 |
10 Person Homes, Tier 2 |
ROS |
$179.21 |
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H2022 |
10 Person Homes, Tier 3 |
ROS |
$203.86 |
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H2022 |
10 Person Homes, Tier 4 |
ROS |
$255.94 |
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H2022 |
12 Person Homes, Tier 1 |
ROS |
$157.65 |
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H2022 |
12 Person Homes, Tier 2 |
ROS |
$160.73 |
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H2022 |
12 Person Homes, Tier 3 |
ROS |
$185.38 |
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H2022 |
12 Person Homes, Tier 4 |
ROS |
$240.53 |
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Group Day Support Services |
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Procedure Code |
Code Description |
Location |
Rate Effective 1/1/2021 |
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97150 |
Tier 1 |
NOVA |
$10.43 |
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97150 |
Tier 1 |
ROS |
$8.90 |
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97150 |
Tier 2 |
NOVA |
$13.84 |
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97150 |
Tier 2 |
ROS |
$11.75 |
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97150 |
Tier 3 |
NOVA |
$16.42 |
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97150 |
Tier 3 |
ROS |
$13.98 |
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97150 |
Tier 4 |
NOVA |
$21.56 |
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97150 |
Tier 4 |
ROS |
$18.33 |
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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 |
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KEPRO Service authorization information for fee-for-service members. |
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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
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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 |
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Aetna Better Health of Virginia |
aetnabetterhealth.com/virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 |
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United Healthcare |
Uhccommunityplan.com/VA and myuhc.com/communityplan
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Virginia Premier |
1-800-727-7536 (TTY: 711) |
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