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Temporary PACE Flexibilities Ending May 11, 2023

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Bulletin
Effective Date:

To:
Programs of All-Inclusive Care for the Elderly (PACE) Providers
From:
Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify PACE providers that current statutory and regulatory PACE program requirements must be followed starting May 12, 2023.  This includes the requirement to conduct in- person participant assessments in accordance with 42 CFR § 460.104, and signature requirements for the enrollment process.

Signature flexibilities and the flexibility to use remote technology for scheduled and unscheduled participant assessments, care planning, monitoring, communication, and other related activities that would normally occur on an in-person basis will end and coincides with the ending of the COVID-19 national emergency and public health emergency declarations, effective May 11, 2023.

For more information, please review the March 24, 2023 Memo sent by the Centers for

Medicare and Medicaid Services (CMS) to PACE Organizations.

CMS

 

 

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.

https://vamedicaid.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 behavioral health service information, visit:

www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or

Call: 1-800-424-4046

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373

Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com

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

 1-855-270-2365

 1-866-386-7882 (CCC+)

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-833-207-3120

1-833-235-2027 (CCC+)

Molina Complete Care

 

1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care

1-800-643-2273

1-844-374-9159 (CCC+)

 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

www.myuhc.com/communityplan

1-844-284-0149

1-855-873-3493 (CCC+)

Virginia Premier

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

Dental Provider

DentaQuest

1-888-912-3456