Personal Care Rate Update Effective July 1, 2020
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The purpose of this bulletin is to inform providers of an increase, effective July 1, 2020, in the rates for personal care services. Pursuant to Item 313.SSSS(1) of the 2020 Appropriation Act, there will be a 5% increase in the rates for agency and consumer directed personal care, respite and companion services in the home and community based services waivers and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) program.
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Agency Directed |
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Procedure Code |
Service Description |
Location |
Rates Effective 7/1/2020 |
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T1019 |
Personal Care |
NOVA |
$16.94 |
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T1019 |
Personal Care |
ROS |
$14.39 |
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T1005 |
Respite Care |
NOVA |
$16.94 |
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T1005 |
Respite Care |
ROS |
$14.39 |
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S5135 |
Companion Care |
NOVA |
$16.94 |
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S5135 |
Companion Care |
ROS |
$14.39 |
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Consumer Directed |
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Procedure Code |
Service Description |
Location |
Rates Effective 7/1/2020 |
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S5126 |
Personal Care |
NOVA |
$12.78 |
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S5126 |
Personal Care |
ROS |
$9.87 |
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S5150 |
Respite Care |
NOVA |
$12.78 |
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S5150 |
Respite Care |
ROS |
$9.87 |
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S5136 |
Companion Care |
NOVA |
$12.78 |
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S5136 |
Companion Care |
ROS |
$9.87 |
Rate Updates Effective 7/1/2020
Waiver rates are posted on the DMAS website at http://www.dmas.virginia.gov/#/longtermwaivers. For questions on personal care reimbursement, 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 Web Portal, individuals enrolled in the new adult 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.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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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 |
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KEPRO Service authorization information for fee-forservice members. |
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and the 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 feefor-service individuals. |
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Medallion 4.0 Managed Care Program |
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CCC Plus Managed Care Program |
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PACE Program |
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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 |
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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 |