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This bulletin is an update to the July 8, 2024, bulletin notifying providers of the rate updates to Psychiatric Residential Treatment Facilities (PRTFs) and Addiction and Recovery Treatment Services (ARTS) in accordance with Items 288.HH.3 and 288.HH.5 of the 2024 Appropriation Act. 

The rates effective July 1, 2024, have been revised to reflect the correct inflation rates and can be found on the DMAS website at https://dmas.virginia.gov/for-providers/rates-and-rate-setting/ in the PRTF/ARTS section under the Behavioral Health heading. DMAS will reprocess any Fee-For-Service claims impacted by this revision.

The MCOs will automatically reprocess any claims for ASAM 3.3, 3.5, and 3.7 that paid using old rates within approximately 30 days after they finish updating their systems to the new rates. Currently, providers have the option to bill MCOs immediately under old rates or delay billing until FY2025 rates are updated by the MCOs.

If you have any questions regarding PRTF or ARTS rates or upcoming reimbursement changes, please contact the DMAS Helpline at 1-800-552-8627.

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.