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Developmental Disabilities (DD) Waivers Rate Updates Effective July 1, 2021

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Bulletin
Effective Date:

To:
All Providers of Developmental Disabilities (DD) Waivers Services
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The 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

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/

 

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

 

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

Magellan Complete Care of Virginia

www.MCCofVA.com

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

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