Top Mobile Menu Bottom Mobile Menu

Search For:

Project BRAVO: Behavioral Health Redesign for Access, Value & Outcomes, Reimbursement Rates for New Enhanced Behavioral Health Services Effective July 1, 2021 and the new Mental Health Services Manual (Formerly Community Mental Health Rehabilitation

Download PDF Download PDF
Bulletin
Effective Date:

To:
All Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to provide information about the reimbursement rates for the set of enhanced behavioral health services scheduled to begin for dates of service on or after July 1, 2021. The program design, service definitions, and benefit requirements will be posted for public comment in April 2021 as an Appendix to the newly re-named “Mental Health Services” Provider Manual (formerly known as the Community Mental Health and Rehabilitative Services Manual).  Please see below for details and instructions on providing public comment.

In accordance with the amended and reenacted 2020 Virginia Acts of Assembly, Chapter 56, Item 313 YYY (2020 Appropriations Act), implementation of these new services under Project BRAVO (Behavioral Health Redesign for Access, Value and Outcomes), will begin July 1, 2021 with Mental Health Partial Hospitalization Program (MH-PHP), Mental Health Intensive Outpatient (MH-IOP) and Assertive Community Treatment (ACT). Multisystemic Therapy, Functional Family Therapy, Mobile Crisis, Community Stabilization, 23-hour Observation and Residential Crisis Stabilization services will follow, with implementation on December 1, 2021.  This bulletin provides the reimbursement rates for the services scheduled to begin on July 1, 2021.  DMAS will provide more information on the rates for services scheduled for December 1, 2021 at a later date.

Reimbursement Rates for New and Affected Services for dates of service on or after July 1, 2021:

Service Name

Start Date

Procedure Code

 

Type of Program

Rate

Mental Health Partial Hospitalization Program (MH-PHP)

7/1/2021

H0035

 

Community-Based Clinic Program

$121.62/per diem

 

Hospital Based Mental Health Program

$222.76/per diem

 

Service Name

Start Date

Procedure Code

Modifier

Modifier Meaning

Rate

Mental Health Intensive Outpatient (MH-IOP)

7/1/2021

S9480

None

 

$141.51/per diem

GO

With Occupational Therapy

$142.96/per diem

 

 

Service Name

Start Date

Procedure Code

Modifier

Modifier Meaning

Rate

Assertive Community Treatment (ACT)

7/1/2021

H0040

none

Contracted as Base Fidelity  Large Team

$158.90/per diem

U1

Contracted as Base Fidelity Medium Team

$169.33/per diem

U2

Contracted as Base  Fidelity Small Team

$195.20/per diem

U3

Contracted as High Fidelity Large Team

$190.08/per diem

U4

Contracted as High Fidelity Medium Team

$206.64/per diem

U5

Contracted as High Fidelity Small Team

$245.29/per diem

 

Service Name

Start Date

Procedure Code

   

Rate

Psychotherapy for Crisis

7/1/2021

90839

 

 

$127.24/Facility Rate

$144.23/Non Facility Rate

90840

 

 

$60.33/Facility Rate

$68.30/Non Facility Rate

DMAS Provider Manual

Policy and regulatory information will be posted on the Regulatory Town Hall for a 30-day public comment period.  Please refer to DMAS Memo dated 06/01/2017, How to Receive Notice of and Submit Comments on DMAS Manual and Regulatory Changes for instructions on how to sign up for notifications here: https://www.virginiamedicaid.dmas.virginia.gov/ECMPdfWeb/ECMServlet?memospdf=Medicaid+Memo+2017.05.19.pdf

After public comment has ended and the policies have received approval, the policies will be posted here: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual

Training

DMAS is developing training sessions on the enhanced services. These sessions will review the

new services including provider requirements, covered services, documentation and billing

requirements. These sessions will be recorded and made available on the DMAS Behavioral Health Enhancement website.  DMAS will send out notification via a Magellan of Virginia e-blast when the recordings are available on the DMAS website.

Virtual Training Session #1

Assertive Community Treatment

Date & Time

May 25, 2021 @ 10:00am-12:00pm

Web Link

https://covaconf.webex.com/covaconf/onstage/g.php?MTID=ed02cfde027a13881e0c86e138521e3f2

Call-In:

1-866-692-4530

Access code:

185 152 1572

Password:

nT2dt4RtRU7

 

Virtual Training Session #2

Intensive Outpatient and Partial Hospitalization Program

Date & Time

May 26, 2021 @ 1:00pm-3:00pm (this is a change)

Web Link:

https://covaconf.webex.com/covaconf/onstage/g.php?MTID=ee52f2bc4b2e0b63f793cbe7528f067cb

Call-In:

1-866-692-4530

Access code:

185 564 7662

Password:

KzN3iNk2zj4

Learning collaborative groups for providers of these services will be established through the existing stakeholder workgroups to support ongoing implementation and sustainability for these services; these groups will begin following the July 1, 2021 implementation. Information on the format will be available at a later date. DMAS will also seek to involve members participating in these services to provide feedback on their experiences for ongoing process improvement.

For questions, please email: enhancedbh@dmas.virginia.gov

*************************************************************************************

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

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

KEPRO

Service authorization information for fee-for-service members.

 

 

https://dmas.kepro.com/

 

Provider Appeals

DMAS is launching an appeal portal in late May 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. 

https://www.dmas.virginia.gov/#/appealsresources

 

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.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

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

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

www.aetnabetterhealth.com/Virginia

 1-800-279-1878

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-800-901-0020

Magellan Complete Care of Virginia

www.MCCofVA.com

 1-800-424-4518 (TTY 711) or 1-800-643-2273

Optima Family Care

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

and www.myuhc.com/communityplan

1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711), www.virginiapremier.com