Developmental Disabilities (DD) Waivers Rate Updates Effective July 1, 2021
Download PDFThe purpose of this bulletin is to inform providers of rate updates to DD Waiver services including Independent Living Supports, Supported Living, In-home Support Services, Group Supported Employment, Workplace Assistance, Community Engagement, Community Coaching, Therapeutic Consultation, select Group Day Support, and select Group Home services. Rate updates have been made in consultation with the Department of Behavioral Health and Developmental Services (DBHDS) in accordance with the 2021 Virginia Acts of Assembly Item 313.DDDD. The rate changes are shown in the tables below and will be posted on the DMAS website at: https://www.dmas.virginia.gov/for-providers/long-term-care/waivers/.
DD Waivers Rate Changes Effective July 1, 2021
In accordance with Item 313.DDDD.2 rates for Independent Living Supports, Supported Living, In-home Support Services, Group Supported Employment, Workplace Assistance, Community Engagement, Community Coaching, and Therapeutic Consultation have been increased. Please note Community-Based Crisis Supports (H0040) will move to procedure code S9484 for dates of service on or after July 1, 2021. Procedure code H0040 will be used for Assertive Community Treatment (ACT) for dates of service on or after July 1, 2021. Refreshed DD Waivers rates effective on and after July 1, 2021 are found in the table below.
Procedure Code |
Modifier |
Procedure Description |
Tier/Size |
Location |
Rate Effective 7/1/2021 |
97139 |
|
Therapeutic Consultation, Therapist, Behavior Analyst, Rehab. Engineers |
|
NOVA |
$100.40 |
97139 |
|
Therapeutic Consultation, Therapist, Behavior Analyst, Rehab. Engineers |
|
ROS |
$94.88 |
97530 |
|
Therapeutic Consultation, Other Professionals |
|
NOVA |
$76.26 |
97530 |
|
Therapeutic Consultation, Other Professionals |
|
ROS |
$68.03 |
H2017 |
|
Therapeutic Consultation, Psychologist/ Psychiatrist |
|
NOVA |
$90.33 |
H2017 |
|
Therapeutic Consultation, Psychologist/ Psychiatrist |
|
ROS |
$78.51 |
H0043 |
|
Supported Living |
Tier 1 |
NOVA |
$171.08 |
H0043 |
|
Supported Living |
Tier 1 |
ROS |
$145.11 |
H0043 |
|
Supported Living |
Tier 2 |
NOVA |
$223.48 |
H0043 |
|
Supported Living |
Tier 2 |
ROS |
$188.68 |
H0043 |
|
Supported Living |
Tier 3 |
NOVA |
$260.95 |
H0043 |
|
Supported Living |
Tier 3 |
ROS |
$219.83 |
H0043 |
|
Supported Living |
Tier 4 |
NOVA |
$330.10 |
H0043 |
|
Supported Living |
Tier 4 |
ROS |
$277.32 |
H2014 |
UA |
In-Home Residential Support |
Size 1 |
NOVA |
$31.97 |
H2014 |
UA |
In-Home Residential Support |
Size 1 |
ROS |
$27.22 |
H2014 |
U2 |
In-Home Residential Support |
Size 2 |
NOVA |
$17.59 |
H2014 |
U2 |
In-Home Residential Support |
Size 2 |
ROS |
$14.97 |
H2014 |
U3 |
In-Home Residential Support |
Size 3 |
NOVA |
$12.79 |
H2014 |
U3 |
In-Home Residential Support |
Size 3 |
ROS |
$10.89 |
|
|
|
|
|
|
|
|
|
|
|
|
H2024 |
UA |
Supported Employment, Group 2 or fewer |
NOVA |
$22.28 |
|
H2024 |
UA |
Supported Employment, Group 2 or fewer |
ROS |
$20.38 |
|
H2024 |
U2 |
Supported Employment, Group more than 2, up to 4 |
NOVA |
$15.42 |
|
H2024 |
U2 |
Supported Employment, Group more than 2, up to 4 |
ROS |
$14.15 |
|
H2024 |
U3 |
Supported Employment, Group more than 4 |
NOVA |
$12.67 |
|
H2024 |
U3 |
Supported Employment, Group more than 4 |
ROS |
$11.64 |
|
H2025 |
|
Workplace Assistance |
|
NOVA |
$35.81 |
H2025 |
|
Workplace Assistance |
|
ROS |
$31.02 |
T2013 |
|
Community Coaching |
|
NOVA |
$35.81 |
T2013 |
|
Community Coaching |
|
ROS |
$31.02 |
T2021 |
|
Community Engagement |
Tier 1 |
NOVA |
$17.02 |
T2021 |
|
Community Engagement |
Tier 1 |
ROS |
$14.93 |
T2021 |
|
Community Engagement |
Tier 2 |
NOVA |
$19.21 |
T2021 |
|
Community Engagement |
Tier 2 |
ROS |
$16.79 |
T2021 |
|
Community Engagement |
Tier 3 |
NOVA |
$22.26 |
T2021 |
|
Community Engagement |
Tier 3 |
ROS |
$19.34 |
T2021 |
|
Community Engagement |
Tier 4 |
NOVA |
$27.65 |
T2021 |
|
Community Engagement |
Tier 4 |
ROS |
$23.90 |
T2032 |
|
Independent Living Supports full month |
Tier 1 |
NOVA |
$1,483.60 |
T2032 |
|
Independent Living Supports full month |
Tier 1 |
ROS |
$1,262.17 |
T2032 |
|
Independent Living Supports full month |
Tier 2 |
NOVA |
$2,453.36 |
T2032 |
|
Independent Living Supports full month |
Tier 2 |
ROS |
$2,087.84 |
T2032 |
U1 |
Independent Living Supports partial month |
Tier 1 |
NOVA |
$741.80 |
T2032 |
U1 |
Independent Living Supports partial month |
Tier 1 |
ROS |
$631.09 |
T2032 |
U1 |
Independent Living Supports partial month |
Tier 2 |
NOVA |
$1,226.68 |
T2032 |
U1 |
Independent Living Supports partial month |
Tier 2 |
ROS |
$1,043.92 |
DD Waivers Rate Revisions Effective July 1, 2021
In accordance with Item 313.DDDD.1, the remaining Group Home Service rates have been updated. Updates include rate corrections for two Group Day Support rates published in the Medicaid Bulletin effective January 1, 2021 on December 18, 2020 to be consistent with the rate model. Revised rates effective on and after July 1, 2021 are found in the table below.
Procedure Code |
Modifier |
Procedure Description |
Tier/ Size |
Location |
Rate Effective 7/1/2021 |
97150 |
|
Group Day |
Tier 1 |
NOVA |
$10.38 |
97150 |
|
Group Day |
Tier 2 |
NOVA |
$13.78 |
H2022 |
U6 |
Group Home Supports 9 Person Home |
Tier 1 |
NOVA |
$208.90 |
H2022 |
U6 |
Group Home Supports 9 Person Home |
Tier 2 |
NOVA |
$223.72 |
H2022 |
U6 |
Group Home Supports 9 Person Home |
Tier 2 |
ROS |
$188.45 |
H2022 |
U6 |
Group Home Supports 9 Person Home |
Tier 3 |
NOVA |
$253.37 |
H2022 |
U6 |
Group Home Supports 9 Person Home |
Tier 4 |
NOVA |
$314.14 |
H2022 |
U7 |
Group Home Supports 10 Person Home |
Tier 1 |
NOVA |
$201.48 |
H2022 |
U7 |
Group Home Supports 10 Person Home |
Tier 1 |
ROS |
$169.97 |
H2022 |
U7 |
Group Home Supports 10 Person Home |
Tier 2 |
NOVA |
$212.60 |
H2022 |
U7 |
Group Home Supports 10 Person Home |
Tier 2 |
ROS |
$179.21 |
H2022 |
U7 |
Group Home Supports 10 Person Home |
Tier 3 |
NOVA |
$242.25 |
H2022 |
U7 |
Group Home Supports 10 Person Home |
Tier 4 |
NOVA |
$304.88 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 1 |
NOVA |
$194.08 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 1 |
ROS |
$163.80 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 2 |
NOVA |
$201.48 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 2 |
ROS |
$169.97 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 3 |
NOVA |
$231.13 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 3 |
ROS |
$194.62 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 4 |
NOVA |
$295.62 |
H2022 |
U8 |
Group Home Supports 11 Person Home |
Tier 4 |
ROS |
$248.23 |
H2022 |
U9 |
Group Home Supports 12 Person Home |
Tier 1 |
NOVA |
$186.66 |
H2022 |
U9 |
Group Home Supports 12 Person Home |
Tier 2 |
NOVA |
$190.36 |
H2022 |
U9 |
Group Home Supports 12 Person Home |
Tier 3 |
NOVA |
$220.01 |
H2022 |
U9 |
Group Home Supports 12 Person Home |
Tier 4 |
NOVA |
$286.34 |
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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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1-800-884-9730 or 1-800-772-9996 |
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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. |
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1-800-881-2166 www.optimahealth.com/medicaid |
United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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