Update to 1915(c) Home and Community Based Services (HCBS) Waivers Amendments - Implementation of Combined Budget for Assistive Technology and Electronic Home Based Supports Effective September 1, 2025
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The purpose of this bulletin is to provide additional clarification to the Medicaid Bulletin “Update to Pending 1915(c) Home and Community-Based Services (HCBS) Waivers Amendments” dated June 10th, 2025.
The prior bulletin stated that effective September 1, 2025, the annual service limits for Assistive Technology (AT) and Electronic Home-Based Services (EHBS) will be combined between the two services into an annual, calendar year shared limit of $10,000 to be authorized according to the members’ needs. This applies to the Building Independence, Family and Individual Supports, and Community Living waivers.
The applicable billing codes are T1999 and T1999-U5 for AT and A9279 for EHBS.
Environmental modifications (S5165 or 99199) are not included as part of the $10,000 combined budget for AT and EHBS. The budget for environmental modifications is stand alone and remains at $5,000 for the calendar year.
The $10,000 budget for AT and EHBS for the year 2025 will be retroactive to January 1st, 2025.
This means the costs of any AT and EHBS services that were utilized from January 1st, 2025 - September 1st, 2025, will be subtracted from the individual’s new $10,000 combined budget for both services for the year 2025.
For example: An individual has a previous plan year of March 1, 2024 - February 28, 2025, and a current plan year of March 1, 2025 - February 28, 2026. The individual utilized the following AT and EHBS services:
ISP Plan Year Partial Timeframe | AT Budget Used | EHBS Budget Used |
Jan. 1 - Feb. 28, 2025 | $500 | $830 |
Mar. 1 - Sept. 1, 2025 | $0 | $2,500 |
For the 2025 combined AT and EHBS budget period, the amount of AT and EHBS services used thus far is:
$500 + $830 + $2,500 = $3,830.
The remaining amount that can be used for any combination of AT or EHBS in 2025 is:
$10,000 - $3,830 = $6,170.
In this example, from September 1, 2025 - December 31, 2025, the individual has a budget of $6,170 available for either AT or EHBS or some combination of the two services. The combined total utilized across the two services cannot be more than this amount.
Starting January 1, 2026, the AT and EHBS combined budget will be reset to $10,000 for the new calendar year.
Costs cannot be carried over from one calendar year to another (i.e., a requested service cannot be split between 2 authorization periods to approve part of funding in one calendar year and remaining funding for same item in next year).
Policies and documentation requirements specific to DD Waiver providers are included in the Developmental Disabilities Waivers Provider Manual Chapter IV. These include the Individual Support Plan (ISP) and Plan for Supports (PFS) requirements, documentation requirements, and allowable activities for AT and EHBS.
All Developmental Disabilities Waivers Provider Manual chapters, including the Chapter IV are located HERE.
Questions?
Questions related to DMAS requirements for the AT and EHBS 10k combined budget can be sent to ddwaiver@dmas.virginia.gov
To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions. Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.
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. | |
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 |
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. | |
Managed Care Programs Cardinal Care Managed Care 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. | |
Cardinal Care Managed Care | https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-… |
PACE | |
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 | https://www.aetnabetterhealth.com/virginia/providers/index.html 1-800-279-1878
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Anthem HealthKeepers Plus | 1-800-901-0020
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Humana Healthy Horizons Provider Services Call Center | 1-844-881-4482 (TTY: 711) |
Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
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United Healthcare | 1-844-284-0146
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Acentra Health Behavioral Health and Medical Service Authorizations | https://vamedicaid.dmas.virginia.gov/sa 1-804-622-8900 |
Dental Provider DentaQuest | 1-888-912-3456 |
Fee-for-Service (POS) Prime Therapeutics
| https://www.virginiamedicaidpharmacyservices.com/ 1-800-932-6648 |