New Case Management Service for Persons with Traumatic Brain Injury

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Memo

August 28, 2023, 3:57PM

To:

Case Management Services Providers and Contracted Managed Care Organizations

From:

Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The Department of Medical Assistance Services is pleased to announce a new targeted case management service that is designed to provide service coordination and person-centered planning with members who have sustained a traumatic brain injury. In accordance with HB680, the 2022 Virginia General Assembly, DMAS is updating the State Plan for Medical Assistance to include a provision for the payment of Medicaid targeted case management. This new case management service will support members who have sustained a traumatic brain injury on or after the age of 18 and who meet the medical necessity criteria for the service. DMAS has worked extensively with relevant stakeholders to develop the relevant service definitions, administrative and program structures, and eligibility criteria defined this new provider manual supplement. Brain Injury Services Case Management is not part of a Medicaid waiver or specifically affiliated with any set of existing DMAS service systems. Please note that there are members receiving a wide variety of services who may be eligible to receive the Brain Injury Services Case management service. To access this service members or their representatives shall contact their Managed Care Organization noted at the end of this memorandum or the DMAS High Needs Supports team by using the contacts listed on the DMAS website HERE.

Please refer to the DMAS Brain Injury Services website HERE for more details on services including the service specific training dates to be scheduled during September of 2023.

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

Acentra Health

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

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

Call: 1-800-424-4046

Provider Enrollment