End of COVID-19 Flexibilities: Vaccines and Testing Effective October 1, 2024
Download PDF
The purpose of this bulletin is to inform providers of the changes to COVID-19 vaccines and COVID-19 testing policies based on the September 30, 2024, end to federal funding for COVID-19 flexibilities. These changes apply to all DMAS fee-for-service (FFS) and all contracted managed care organizations.
Effective October 1, 2024, DMAS will continue to reimburse all ACIP approved commercially available COVID-19 vaccines. The enhanced $40 vaccine administration fee for pharmacy providers will be discontinued. Vaccine administration fee will be reimbursed at our customary rate for all providers.
Effective October 1, 2024, DMAS will no longer reimburse COVID-19 at home, self swab testing products. Rapid COVID-19 tests and Polymerase chain reaction (PCR tests) COVID-19 tests will be covered by providers as listed below:
| SELF SWAB COVID-19 TESTS | RAPID and PCR COVID-19 TESTS |
At home | NO |
|
Pharmacies | NO |
|
Medical Providers |
| YES |
FQHC |
| YES |
Clinics |
| YES |
*The Federal government will resume offering up to four free at-home COVID-19 test using the COVIDtests.gov website in late September 2024.
3. Currently Lagevrio is an investigational drug without FDA approval, Without FDA approval, Lagevrio will not be covered under the Medicaid pharmacy or medical benefit.
Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | |
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 |
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. | |
Managed Care Programs Cardinal Care Managed Care 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. | |
Cardinal Care Managed Care | https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-… |
PACE | |
Acentra Health Behavioral Health Services
| |
Provider Enrollment | In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
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 | https://www.aetnabetterhealth.com/virginia/providers/index.html 1-800-279-1878
|
Anthem HealthKeepers Plus | 1-800-901-0020
|
Molina Complete Care
| 1-800-424-4524 https://www.molinahealthcare.com/providers/va/medicaid/home.aspx
|
Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
|
United Healthcare | 1-844-284-0149
|
Dental Provider DentaQuest | 1-888-912-3456 |