Top Mobile Menu Bottom Mobile Menu

Search For:

Rate Changes for Congregate Residential and Personal Care Services – Effective July 1, 2009

Download PDF
Memo
Effective Date:

To:
All Personal Care and Related Services Providers; Intellectual Disabilities (ID) Waiver Providers
From:
Patrick W. Finnerty, Director Department of Medical Assistance Services (DMAS)

 

The purpose of this memo is to inform you of changes in the payment rates for congregate residential and personal care services effective for dates of service on or after July 1, 2009. As directed in the 2009 Appropriation Act:

 

  1. Congregate Residential rates under the Intellectual Disabilities Waiver were increased

3.6 percent, effective July 1, 2008. Effective July 1, 2009, the 3.6 percent increase is replaced by a 2-percent increase above rates in effect for state fiscal year 2008. This change is mandated by Item 306.TT of the Act.

 

The following rates will be implemented for dates of service on or after July 1, 2009:

 

National Code

NOVA/ ROS

Code Description

Rates Effective 7/1/2008

New Rates Effective 7/1/2009

97535

NOVA

Congregate Residential Support

$17.63

$17.36

97535

ROS

Congregate Residential Support

$15.33

$15.10

 

NOVA=Northern Virginia ROS=Rest of State

 

  1. Personal Care Services rates shall increase under the department’s home and community-based care waivers by 3 percent on July 1, 2009, as mandated by Item 306.CCC of the Act. Personal Care Services include personal care, respite care and companion care services provided in the EDCD, HIV/AIDS, ID, and DD waivers, the Children’s Mental Health Program, and Early Periodic Screening Diagnosis and Treatment (EPSDT) Program. The increase is for both agency and consumer-directed personal care services and service facilitation services furnished for consumer-directed personal care services.

 

 

 

The following rates will be implemented for dates of service on or after July 1, 2009:

 

National Code

 

NOVA/ ROS

 

 

Code Description

Rates Effective 7/1/2007

New Rates Effective 7/1/2009

 

S5126

 

NOVA

Consumer Directed Personal Assistance/Attendant Care

 

$11.14

 

$11.47

 

S5126

 

ROS

Consumer Directed Personal

Assistance/Attendant Care

 

$8.60

 

$8.86

S5135

NOVA

Companion Services

$14.76

$15.20

S5135

ROS

Companion Services

$12.53

$12.91

 

S5136

 

NOVA

Consumer Directed Companion Services

 

$11.14

 

$11.47

 

S5136

 

ROS

Consumer Directed Companion

Services

 

$8.60

 

$8.86

S5150

NOVA

Consumer-Directed Respite Services

$11.14

$11.47

S5150

ROS

Consumer-Directed Respite Services

$8.60

$8.86

T1005

NOVA

Respite Care

$14.76

$15.20

T1005

ROS

Respite Care

$12.53

$12.91

T1005

NOVA

Respite Care - HIV/AIDS Waiver

$15.87

$16.35

T1005

ROS

Respite Care - HIV/AIDS Waiver

$13.99

$14.41

T1019

NOVA

Personal Care

$14.76

$15.20

T1019

ROS

Personal Care

$12.53

$12.91

T1019

NOVA

Personal Care-HIV/AIDS Waiver

$15.87

$16.35

T1019

ROS

Personal Care-HIV/AIDS Waiver

$13.99

$14.41

 

H2000

 

NOVA

Service Facilitation Initial Comprehensive Visit

 

$226.03

 

$232.81

 

H2000

 

ROS

Service Facilitation Initial

Comprehensive Visit

 

$174.12

 

$179.34

 

S5109

 

NOVA

Service Facilitation Consumer Training Visit

 

$224.95

 

$231.70

 

S5109

 

ROS

Service Facilitation Consumer Training Visit

 

$173.04

 

$178.23

 

S5116

 

NOVA

Service Facilitation Management Training Hours

 

$28.12

 

$28.96

 

S5116

 

ROS

Service Facilitation Management Training Hours

 

$21.63

 

$22.28

99509

NOVA

Service Facilitation Routine Visit

$70.30

$72.41

99509

ROS

Service Facilitation Routine Visit

$54.08

$55.70

 

T1028

 

NOVA

Service Facilitation Reassessment Visit

 

$113.56

 

$116.97

 

T1028

 

ROS

Service Facilitation Reassessment

Visit

 

$86.52

 

$89.12

 

NOVA=Northern Virginia    ROS=Rest of State

 

REQUESTS FOR DUPLICATE REMITTANCE ADVICES

In an effort to reduce operating expenditures, requests for duplicate provider remittance advices will no longer be printed and mailed free of charge. Duplicate remittance advices will be processed and

 

 

sent via secure email. A processing fee for generating duplicate paper remittance advices will be applied to paper requests, effective July 1, 2009.

 

ELIGIBILITY VENDORS

DMAS has contracts with the following eligibility verification vendors offering internet real-time, batch and/or integrated platforms. Eligibility details such as eligibility status, third party liability,  and service limits for many service types and procedures are available. For more information on the services that are offered contact the vendors:

 

Passport Health Communications, Inc. www.passporthealth.com sales@passporthealth.com

Telephone #: (888) 661-5657

 

SIEMENS Medical Solutions – Health Services Foundation Enterprise Systems/HDX www.hdx.com

Telephone #: (610) 219-2322 Emdeon

www.emdeon.com Telephone #: (877) 363-3666

 

ELIGIBILITY AND CLAIMS STATUS INFORMATION

DMAS offers a web-based Internet option (ARS) to access information regarding Medicaid or FAMIS eligibility, claims status, check status, service limits, prior authorization, and pharmacy prescriber identification. The website address to use to enroll for access to this system is http://virginia.fhsc.com. The MediCall voice response system will provide the same information and can be accessed by calling 1-800-884-9730 or 1-800-772-9996. Both options are available at no cost to the provider.

 

Providers must check the recipient’s eligibility via the web-based system or MediCall to verify enrollment in Plan First. The system will have a prompt stating the enrollee has “family planning coverage only”. There is not an identifier on the Medicaid card to alert the provider of Plan First enrollment.

 

"HELPLINE"

The "HELPLINE" is available Monday through Friday from 8:30 a.m. to 4:30 p.m., except on state holidays, to answer questions. The "HELPLINE" numbers are:

 

1-804-786-6273                                       Richmond area and out-of-state long distance 1-800-552-8627 All other areas (in-state, toll-free long distance)

 

Please remember that the "HELPLINE" is for provider use only. Please have your Medicaid provider identification number available when you call.

 

Image removed.COPIES OF MANUALS

Image removed.DMAS publishes electronic and printable copies of its Provider Manuals and Medicaid Memoranda on the DMAS website at www.dmas.virginia.gov. Refer to the “DMAS Content Menu” column on the left-hand side of the DMAS web page for the “Provider Services” link, which takes you to the “Manuals, Memos and Communications” link. This link opens up a page that contains all of the various communications to providers, including Provider Manuals and Medicaid Memoranda. The

 

 

Internet is the most efficient means to receive and review current provider information. If you do not have access to the Internet or would like a paper copy of a manual, you can order it by contacting Commonwealth-Martin at 1-804-780-0076. A fee will be charged for the printing and mailing of the manuals and manual updates requested.

 

PROVIDER E-NEWSLETTER SIGN-UP

DMAS is pleased to inform providers about the creation of a new Provider E-Newsletter. The intent of this electronic newsletter is to inform, communicate, and share important program information with providers. Covered topics will include changes in claims processing, common problems with billing, new programs or changes in existing programs, and other information that may directly affect providers. If you would like to receive the electronic newsletter, please sign up at www.dmas.virginia.gov/pr-enewsletter.asp.

 

Please note that the Provider E-Newsletter is not intended to take the place of Medicaid Memos, Medicaid Provider Manuals, or any other official correspondence from DMAS.