Personal Care Rate Update Effective July 1, 2022
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The purpose of this bulletin is to inform providers that rates for personal care services will increase, effective July 1, 2022.
As stated in the June 28, 2022 bulletin on “Implementation of new rates from 2022 State Budget Appropriations,” DMAS is diligently working on the implementation of new rates set forth in the 2023 Appropriation Act approved by Governor Youngkin June 22, 2022. The new fiscal year 2023 rates may not be posted online before July 1, 2022. At this time providers have the option to bill immediately under old rates, and later adjust their claims or delay billing until rates are updated. Additionally, Managed Care Organizations (MCOs) are working to update their rate systems, but providers will need to work with their MCO partners to determine billing procedures.
In accordance with Item 304 #DDDD of the 2022 Virginia Acts of Assembly, Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care rates will increase by 7.5%. Please find the new rates for personal care in the tables below.
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Agency Directed |
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Procedure Code |
Description |
Region |
Rates Effective 7/1/2022 |
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T1019 |
Personal Care |
NOVA |
$21.79 |
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T1019 |
Personal Care |
ROS |
$18.51 |
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T1005 |
Respite Care |
NOVA |
$21.79 |
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T1005 |
Respite Care |
ROS |
$18.51 |
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S5135 |
Companion Care |
NOVA |
$21.79 |
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S5135 |
Companion Care |
ROS |
$18.51 |
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Consumer Directed |
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Proc Code |
Description |
Region |
Rates Effective 7/1/2022 |
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S5126 |
Personal Care |
NOVA |
$16.45 |
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S5126 |
Personal Care |
ROS |
$12.70 |
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S5150 |
Respite Care |
NOVA |
$16.45 |
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S5150 |
Respite Care |
ROS |
$12.70 |
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S5136 |
Companion Care |
NOVA |
$16.45 |
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S5136 |
Companion Care |
ROS |
$12.70 |
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Personal Care Rates Effective July 1, 2022
This memo serves as the official notification that personal care rates effective July 1, 2022 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.
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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-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. |
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), 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. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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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 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Molina Complete Care
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1-800-424-4524 (CCC+) 1-800-424-4518 (M4) |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |