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The purpose of this bulletin is to inform you that effective July 1, 2020 the rates for home health providers will be increased to reflect a 2.6% inflation adjustment. This action is in accordance with Chapter 12 of the Virginia Administrative Code (VAC) Section 30-80-180(C)(4) that mandates the annual inflation adjustment for home health providers. Home health rates are published on the DMAS Rate Setting website at http://www.dmas.virginia.gov/#/ratesetting under the ribbon entitled “Home Health”.  

Effective January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) implemented the Patient-Driven Groupings Model (PDGM) home health reimbursement methodology for Medicare. PDGM implementation will not affect Medicaid home health billing or reimbursement. Medicaid reimburses providers for the coinsurance and deductible amounts on Medicare claims for Medicaid recipients who are dually eligible for Medicare and Medicaid. However, the amount paid by Medicaid, in combination with the Medicare payment, will not exceed the amount Medicaid would pay for the service if it were billed solely to Medicaid. Additional information about this reimbursement policy can be found in the October 28, 2003 Medicaid Memo.  Note that Medicare has suspended sequestration effective May 1, 2020 through December 31, 2020.

For questions, please contact Sara Benoit by email: Sara.Benoit@dmas.virginia.gov, or by phone: (804)786-3673. 

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Medicaid Expansion Eligibility Verification

Medicaid coverage for the new expansion adult group began January 1, 2019.  Providers may use the Virginia Medicaid Web Portal and the Medicall audio response systems, as shown in the table below, to verify Medicaid eligibility and managed care enrollment, including for the new adult group.  In the Virginia Medicaid Bulletin: Home Health 

Medicaid Web Portal, individuals eligible in the Medicaid expansion covered group are shown as “MEDICAID EXP.”  If the individual is enrolled in managed care, the “MEDICAID EXP” segment will be shown as well as the “MED4” (Medallion 4.0) or “CCCP” (CCC Plus) managed care enrollment segment.  Eligibility and managed care enrollment information is also available through the DMAS Medicall eligibility verification system. Additional Medicaid expansion resources for providers are available on the DMAS Medicaid Expansion webpage at:  http://www.dmas.virginia.gov/#/medex.