Personal Care Rate Update Effective January 1, 2024
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The purpose of this bulletin is to inform providers that rates for personal care services will increase, effective January 1, 2024.
In accordance with Item 304.YYYY of the 2023 Virginia Acts of Assembly, Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care rates will increase by 5%. Please find the new rates for personal care in the tables below.
Agency Directed | |||
Procedure Code | Description | Region | Rates Effective 1/1/2024 |
T1019 | Personal Care | NOVA | $22.88 |
T1019 | Personal Care | ROS | $19.44 |
T1005 | Respite Care | NOVA | $22.88 |
T1005 | Respite Care | ROS | $19.44 |
S5135 | Companion Care | NOVA | $22.88 |
S5135 | Companion Care | ROS | $19.44 |
Consumer Directed | |||
Procedure Code | Description | Region | Rates Effective 1/1/2024 |
S5126 | Consumer Directed Personal Care | NOVA | $17.27 |
S5126 | Consumer Directed Personal Care | ROS | $13.34 |
S5150 | Consumer Directed Respite Care | NOVA | $17.27 |
S5150 | Consumer Directed Respite Care | ROS | $13.34 |
S5136 | Consumer Directed Companion Care | NOVA | $17.27 |
S5136 | Consumer Directed Companion Care | ROS | $13.34 |
Personal Care Rates Effective January 1, 2024
This memo serves as the official notification that personal care rates effective January 1, 2024 are posted on the DMAS website at https://www.dmas.virginia.gov/for-providers/long-term-care/waivers/. Corrections or revisions will be noted at the bottom of the official rate sheet. If you have any questions regarding personal care rates please call the provider helpline at 800-552-8627.
Appeals Information
If you believe an error was made for payment rates or totals, you can file an appeal. The appeal must be filed with the DMAS Appeals Division through one of the following methods:
Through the Appeals Information Management System at https://www.dmas.virginia.gov/appeals/. From there you can fill out an informal appeal request, submit documentation, and follow the process of your appeal.
Through mail, email, or fax. You can download a Medicaid Provider Appeal Request form at https://www.dmas.virginia.gov/appeals/. You can use that form or a letter to file the informal appeal. The appeal request must identify the issues being appealed. The request can be submitted by:
Mail or delivery to: Appeals Division, Department of Medical Assistance Services, 600 E. Broad Street, Richmond, VA 23219;
Email to appeals@dmas.virginia.gov; or
Fax to (804) 452-5454.
The appeal must be received by the DMAS Appeals Division within 30 days of the payment rate or total being published by DMAS. The notice of appeal is considered filed when it is date stamped by the DMAS Appeals Division. The normal business hours of DMAS are from 8:00 a.m. through 5:00 p.m. on dates when DMAS is open for business. Documents received after 5:00 p.m. on the deadline date shall be untimely.
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 |