Updates to the DD Waiver Provider Manual Chapter 2

Download PDF

Memo

July 8, 2024, 10:00AM

To:

Developmental Disabilities Waiver Providers

From:

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

The purpose of this memorandum is to notify providers that Chapter 2 of the developmental disability waiver manual has been updated with the following changes:

Minor updates to Participation Requirements and Requirements of Section 504 of the Rehabilitation Act to make more applicable to DD waiver.
Supports Intensity Scale (SIS) updates in response to upcoming re-norming to SIS-A Second edition.
Added statement regarding providers allowing support coordinators access to premises.
Added clarifications regarding the use of electronic signatures date stamp.
Added information on Mandatory Provider Remediation process.
Added information on temporary out of state travel for individual’s using waiver services.
Updated individuals right to include accept and decline services and right to choose a provider.
Home and Community Based Services (HCBS) final rule added clarifications and examples of compliance regarding dignity, choices, autonomy, PC ISP, privacy, decorations, physical accessibility, and residential specific HCBS rights.
For PERS and EHBS: clarified providers may not be reimbursed for installation if the individual or family self-installs equipment.
Updated outdated or broken hyperlinks.
Added minor clarifying language to several sections, grammar and format updates and removed duplicate language.
Added back up plan requirement for EHBS.
Minor updates to Consumer Direction and personal assistance to align with CCC+ manual, updated license type to match the licenses DBHDS providers, and statement regarding labor laws.

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

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

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

Program of All-inclusive Care (virginia.gov)

Acentra Health

Behavioral Health Services

https://dmas.kepro.com/

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373

Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com

Provider HELPLINE