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The purpose of this Bulletin is to communicate the Medicaid and Family Access to Medical Insurance Security (FAMIS) flexibilities that will be in place during the temporary Virginia public health emergency declared in Executive Order 84.  The Medicaid and FAMIS flexibilities relate to telehealth, pre-admission screening, durable medical equipment, nursing facilities, personal care, respite, and companion services, and individuals under temporary detention order. 

Telehealth

Health-care practitioners with an active license issued by another state may provide continuity of care to their current patients who are Virginia residents through telehealth services. As of the date of the executive order (January 10, 2022), establishment of a relationship with a new patient requires a Virginia license unless permission has been granted by the applicable Virginia licensing authority.

A health-care practitioner may use any non-public facing audio or remote communication product that is available to communicate with patients, provided that such communication product is not inconsistent with the waivers and flexibilities issued by the United States Department of Health and Human Services and the Centers for Medicare and Medicaid Services. This exercise of discretion applies to telehealth services provided for both COVID-19 and for other diagnosis and treatment services unrelated to COVID-19.

Pre-admission screening

DMAS shall suspend pre-admission screening pursuant to § 32.1-330 of the Code. All new nursing home admissions will be treated as exempted hospital discharges. Community based Long-Term Services and Supports (LTSS) screening teams shall be exempt from face-to-face screenings and may screen for nursing home admission from a community setting or waiver services using telehealth or telephonic screening.

Durable Medical Equipment (DME)

DMAS shall waive requirements pursuant to § 32.1-325(A)(14) of the Code concerning certificates of medical necessity. Any supporting verifiable documentation requirements are waived with respect to replacement of DME. DMAS shall also suspend enforcement of additional replacement requirements for DME, prosthetics, orthotics, and supplies that are lost, destroyed, irreparably damaged, or otherwise rendered unusable, such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement equipment.

Nursing Facilities

Temporary nurse aides practicing in long term care facilities under the federal Public Health Emergency 1135 Waiver may be deemed eligible by the Board of Nursing to take the National Nurse Aide Assessment Program examination upon submission of a completed application, the employer’s written verification of competency and employment as a temporary nurse aide, and provided no other grounds exist under Virginia law to deny the application.

Personal Care, Respite, and Companion Services

Personal care, respite, and companion providers in the agency- or consumer-directed program, who are providing services to individuals over the age of 18, may work for up to 60 days, as opposed to the current 30-day limit in § 32.1-162.9:1 of the Code, while criminal background registries are checked. Consumer-directed Employers of Record must ensure that the attendant is adequately supervised while the criminal background registry check is processed. Agency providers must adhere to current reference check requirements and ensure that adequate training has occurred prior to the aide providing the services in the home. Agency providers shall conduct weekly supervisory visits through telehealth methods when the aide works prior to receiving criminal background registry results. This section does not apply to services provided to individuals under the age of 18, with the exception of parents of minor children in the consumer-directed program.

Individuals Under Temporary Detention Order

Prior to releasing a patient under a temporary detention order for transport to a state-operated psychiatric hospital, providers participating in the State Medicaid Plan must comply with the applicable Criteria for Medical Assessment Prior to Admission to a Psychiatric Hospital, Inpatient Psychiatric or Crisis Stabilization Unit found at:

 http://www.dbhds.virginia.gov/assets/doc/about/masg/adults-medical-and-screening-guidelines-11-5-2018.pdf and http://www.dbhds.virginia.gov/assets/doc/about/masg/peds-medical-assessment-and-screening-guidelines-11-5-2018.pdf. Such providers shall screen patients under emergency custody or temporary detention for COVID-19 in accordance with guidance issued by the Centers for Disease Control and Prevention and the Virginia Department of Health. In addition, with consent of the patient subject to emergency custody or temporary detention, such providers should administer a COVID-19 active infection test prior to the transfer of the patient to a state-operated psychiatric hospital. If no other payment source is available, the Department of Behavioral Health and Developmental Services will reimburse the provider for the cost of the test.

Copays

FAMIS copays are mentioned in Executive Order 84, but please note that Medicaid and FAMIS copays will continue to be suspended until the end of the federal public health emergency, and are not tied to the end date of this state emergency period.

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