Implementation Update for March 1, 2024: Legally Responsible Individuals
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The purpose of this bulletin is to provide an update to the implementation of the new provision of payment to legally responsible individuals (LRI) for personal care services that were scheduled for March 1, 2024 In an effort to support the families who are preparing for the potential changes being discussed in the General Assembly on this topic, the Department sought and received approval from the Centers for Medicare and Medicaid (CMS) to request an extension of some of the temporary federal flexibilities allowed by the Appendix K waiver amendment, described in the Medicaid Memo dated April 22, 2020
The Department will be extending all provisions of the Appendix K except for two which have new fiscal impacts to the Commonwealth.
The Department will implement the following on March 1, 2024:
LRI payments will be limited to 40 hours per week. LRIs are permitted to find other caregivers for the additional hours approved in the plan of care.
2. Respite will not be available when there is a paid LRI.
All other provisions will be delayed until the General Assembly makes a final decision, and the Department submits amendments and receives approvals from CMS for those changes.
Link to DMAS LRI webpage: https://dmas.virginia.gov/for-providers/long-term-care/waivers/legally-responsible-individuals/.
Questions may be directed to CDLRI@dmas.virginia.gov.
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 |
Acentra Health Service authorization information for fee-for-service members.
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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
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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
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Anthem HealthKeepers Plus | 1-800-901-0020
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Molina Complete Care
| 1-800-424-4524 https://www.molinahealthcare.com/providers/va/medicaid/home.aspx
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Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
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United Healthcare | 1-844-284-0149
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Dental Provider DentaQuest | 1-888-912-3456 |