Rate Changes for Home and Community Based Care Services and Mental Health Therapeutic Day Treatment
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The purpose of this memo is to notify providers of rate changes to home and community based care (HCBC) waiver service and mental health therapeutic day treatment rates for dates of service on or after July 1, 2011.
In accordance with Item 297.NNN.2 of the 2011 Acts of Assembly, Chapter 890, rates for HCBC waiver services in state fiscal year (SFY) 2012 will be reduced by one percent below the rates effective October 1, 2010. The exception to this change is rates for skilled nursing services delivered to recipients in the Technology Assistance Waiver. All waiver rates can be found on the DMAS website: http://dmasva.dmas.virginia.gov, under LTC and Waiver Services, Waiver Services and Rates.
This reduction also applies to personal care and nursing services under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program.
Services Specific to EPSDT Program
|
National Code |
Code Description |
Differential |
Rates Effective 7/1/2010- 9/30/10 |
Rates Effective 10/1/10- 6/30/11 |
Rates Effective 7/1/2011 |
|
S9123 |
Nursing Care in home/RN |
ROS |
$24.64 |
$25.94 |
$25.68 |
|
S9124 |
Nursing Care in home/LPN |
NOVA |
25.94 |
$27.30 |
$27.03 |
|
S9124 |
Nursing Care in home/LPN |
ROS |
$21.39 |
$22.52 |
$22.29 |
|
T1019 |
Personal Care (Agency Directed) |
NOVA |
$14.44 |
$15.20 |
$15.05 |
|
T1019 |
Personal Care (Agency Directed) |
ROS |
$12.26 |
$12.91 |
$12.78 |
|
S5126 |
Personal Care (Consumer Directed) |
NOVA |
$10.90 |
$11.47 |
$11.36 |
|
S5126 |
Personal Care (Consumer Directed) |
ROS |
$8.42 |
$8.86 |
$8.77 |
Medicaid Memo: Special May 31, 2011
Page 2
In accordance with Item 297.JJJJ.2 of the 2011 Acts of Assembly, Chapter 890, mental health therapeutic day treatment services in SFY 2012 will be reduced by four percent below the rates in effect on June 30, 2010. The following table describes rates in effect in SFY11 and the change in rates to be implemented for dates of service on or after July 1, 2011:
|
National Code |
Code Description |
Modifier |
Differential |
Rates Effective 7/1/2010- 9/30/10 |
Rates Effective 10/1/10- 6/30/11 |
Rates Effective 7/1/2011 |
|
H0035 |
Mental Health Partial Hospitalization Treatment, Less than 24 hours |
HB |
Non-Child Program |
$35.14 |
$36.23 |
$34.78 |
|
MH Therapeutic Day Treatment for Children and Adolescents |
HA |
Child Program |
$36.91 |
$38.05 |
$36.53 |
|
|
H0032 |
MH Day Treatment Assessment |
U7 |
|
$36.91 |
$38.05 |
$36.53 |
VIRGINIA MEDICAID WEB PORTAL
DMAS offers a web-based Internet option to access information regarding Medicaid or FAMIS member eligibility, claims status, check status, service limits, service authorizations, and electronic copies of remittance advices. Providers must register through the Virginia Medicaid Web Portal in order to access this information. The Virginia Medicaid Web Portal can be accessed by going to: www.virginiamedicaid.dmas.virginia.gov. If you have any questions regarding the Virginia Medicaid Web Portal, please contact the ACS Web Portal Support Helpdesk, toll free, at 1-866-352-0496 from 8:00 A.M. to 5:00 P.M. Monday through Friday, except holidays. The MediCall audio response system provides similar 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 may also access service authorization information including status via iEXCHANGE™ at http://dmas.kepro.com/.
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. Contact information for each of the vendors is listed below.
|
Passport Health |
SIEMENS Medical Solutions – |
Emdeon |
|
Communications, Inc. |
Health Services |
|
|
Foundation Enterprise Systems/HDX |
Telephone: |
|
|
1 (877) 363-3666 |
||
|
Telephone: |
Telephone: |
|
|
1 (888) 661-5657 |
1 (610) 219-2322 |
|
“HELPLINE”
The “HELPLINE” is available to answer questions Monday through Friday from 8:00 a.m. to 5:00 p.m., except on holidays. 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.