Updates to Comprehensive Crisis and Transition Services (Appendix G) of the Mental Health Services Manual
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The purpose of this memorandum is to notify providers of changes to the Comprehensive Crisis and Transition Services (Appendix G) of the Mental Health Services Manual, previously known as the Community Mental Health Services (CMHRS) Manual.
Appendix G contains level of care guidelines, medical necessity criteria, provider participation requirements, service authorization and billing guidance for Mobile Crisis Response, Community Stabilization, 23-Hour Crisis Stabilization and Residential Crisis Stabilization Unit (RCSU) services. In addition to clarifications and a reorganization of existing language, the following changes were made:
- The name and organization of the Appendix was updated to reflect the role of Community Stabilization to serve as a transitional step down from an intensive service such as crisis and inpatient services and other levels of care when there is a gap in availability of services.
- A requirement that supervisors of Registered Peer Recovery Specialists must complete the DBHDS Peer Recovery Specialist Supervisor Training was added to each service.
- Clarifications related to consecutive registrations for Mobile Crisis Response were added.
- Added allowance for individual, group and family therapy to be provided through telemedicine in RCSUs.
- Extended deadline for implementing 24/7 nursing requirement in RCSU to 11/30/2024.
- The medical necessity criteria for Community Stabilization has been updated.
- A requirement has been added that Community Stabilization providers must be credentialed and contracted with the individual’s Medicaid Managed Care Organization (MCO) for individuals enrolled in Medicaid managed care or the Fee for Service (FFS) contractor for individuals in FFS.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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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 |
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KEPRO Service authorization information for fee-for-service members.
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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. |
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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. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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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 For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider Enrollment |
In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
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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 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-855-270-2365 1-866-386-7882 (CCC+) |
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Anthem HealthKeepers Plus |
1-833-207-3120 1-833-235-2027 (CCC+) |
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Molina Complete Care
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1-800-424-4524 (CCC+) 1-800-424-4518 (M4) |
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Optima Family Care |
1-800-643-2273 1-844-374-9159 (CCC+) |
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United Healthcare |
1-844-284-0149 1-855-873-3493 (CCC+) |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |