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Temporary Home and Community Based Services (HCBS) rate update effective July 1, 2021

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Bulletin
Effective Date:

To:
Providers of Home and Community Based Services Waivers (HCBS) and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to inform you of a temporary 12.5% rate increase for select HCBS services in accordance with the Acts of Assembly, 2021 Special Session II, Item E.1. HCBS includes specific waiver services, behavioral health services, home health services, Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services, and other services in compliance with CMS guidance.  A list of eligible procedure and revenue codes for the temporary rate increase are in the table below. The temporary rate increase is not applicable to school services, any customized rates, inpatient services, and rates paid under individual consideration. All services billed for using the procedure and revenue codes listed in the table below are eligible for the 12.5% temporary rate increase for dates of service on or after July 1, 2021 through June 30, 2022. This change will be effective October 8, 2021 for claims billed on or after this date. For claims billed and adjudicated prior to this date, please refer to the “Retrospective Claims” section within this document. Agency-directed and consumer-directed personal care, respite, and companion services will receive the temporary HCBS rate increase until December 31, 2021, when a 12.5% permanent rate increase will be implemented. This action is in accordance with the 2021 Appropriations Act as amended in the Virginia General Assembly Special Session II.

Managed Care Organizations (MCO) and Behavioral Health Services Administrator (BHSA) Magellan will implement these changes on a prospective basis by October 22nd, 2021.  This means that claims with dates of service on or after October 22 will include the increase.  See "Retrospective Claims" for claims billed and adjudicated prior to this date.

 

BILLING CODES

Procedure Codes

Revenue Codes

90839

0373T*

H0024

H2015

S5116

T1002

T1031

421

90840

G0151

H0025

H2016

S5126

T1003

T2013

424

97139

G0152

H0031

H2017

S5135

T1005

T2021

431

97150

G0153

H0032

H2018*

S5136

T1012

T2022

434

97151*

G0493

H0035

H2019*

S5150

T1015

T2023

441

97152*

G0494

H0036*

H2020

S9123

T1016

T2024

444

97153*

G0495

H0038

H2022

S9124

T1017

T2032

550

97154*

G9012

H0039

H2023

S9125

T1019

T2033

551

97155*

H0004

H0040

H2024

S9445

T1020

T2034*

559

97156*

H0005

H0043

H2025

S9480

T1023

 

571

97157*

H0006

H0046

H2033*

S9482*

T1024

   

97158*

H0014

H2000

H2034

S9484*

T1026

   

97530

H0015

H2011*

S0201

S9485*

T1027

   

99509

H0020

H2012

S5102

T1000

T1028

   

0362T*

H0023

H2014

S5109

T1001

T1030

   

Procedure codes marked with an asterisk (*) have services and rates that will be effective December 1, 2021. Rates, rate increases, and specific procedure codes effective December 1, 2021 are subject to change. Existing services and service rates listed in the table above are subject to claims payment processing procedures and may not result in increased payments when not used for HCBS as outlined by federal and state guidance.

Retrospective Claims

The Department of Medical Assistance Services (DMAS) is working with our partners at the Centers for Medicare & Medicaid Services (CMS), the MCOs, Behavioral Health Services Administrator (BHSA) Magellan, and other State vendors to determine options for the State to adjust previously billed and adjudicated claims with dates of services between July 1, 2021 and October 7, 2021.  The State is seeking options to alleviate provider burden and will share subsequent information in a bulletin once federal guidance has been obtained.

Temporary HCBS Rate Update

New rates will be posted on the DMAS website at the following locations:

Mental Health service rates can be found at: https://www.dmas.virginia.gov/for-providers/behavioral-health/

Temporary HCBS Rate Increase

This bulletin serves as the official notification that the temporary rates are posted on the DMAS website at http://www.dmas.virginia.gov/. Please use the contact information listed below if you have any questions or concerns.

     HCBS Services:

CCC Plus Waiver Claims

Virginia Medicaid Provider Helpline

 

Phone (Toll Free) - 800-552-8627

Phone (In State) -   804-786-6273

DD Waiver Claims

Virginia Medicaid Provider Helpline

 

Phone (Toll Free) - 800-552-8627

Phone (In State) - 804-786-6273

 

 

MCO Claims: 

CCC Plus

DMAS Website

MCO Directories by Region

(Claims Contact)

 

https://dmas.virginia.gov/for-providers/managed-care/ccc-plus/provider-resources/

 

 

MCO Claims:

Medallion 4.0

Aetna

Claims Inquiry Claims Research (CICR) team

1-800-279-1878 

Select the appropriate prompt for all other Claims issues.

Anthem

Brandon Hutchins-757-272-2593

brandon.hutchins@anthem.com

Molina

DMAS Website

https://dmas.virginia.gov/for-providers/managed-care/ccc-plus/provider-resources/

Optima

Provider Services Department

https://www.optimahealth.com/providers/frequently-asked-questions

https://www.optimahealth.com/documents/provider-orientation/012-orientation-key-contacts.pdf   

 

United

Tamara (Tami) Sink

+1(952) 406-5037

va_hcbs_pr@uhc.com

Virginia Premier

Claims Customer Service

Main Toll-Free Number: 877-719-7358

Escalation: Contact your dedicated Provider Relations Representative or email the complete detail to contactmyrep@virginiapremier.com

 

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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 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.

https://www.dmas.virginia.gov/appeals/

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