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Updates to the Home and Community Based Services (HCBS) Developmental Disability Waivers Manual

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Memo
Effective Date:

To:
All Support Coordinators/Case Managers and Providers of Community Living (CL), Family and Individual Supports (FIS) and Building Independence (BI) Waiver Services
From:
Cheryl Roberts, Director Department of Medical Assistance Services (DMAS)

 

The purpose of this memorandum is to notify Home and Community Based Services Developmental Disabilities Waiver service providers and support coordinators of the clarifications and changes to the Developmental Disabilities Services manual.

The Services Authorization Appendix (Appendix D) has a slight revision under “Crisis Support Services (Non-Professional)”.

In Chapter 2 (provider requirements), a clause has been added related to 2022 Special Session 1 Virginia Acts of Assembly, Chapter 2, Item 304.OO which permits Certified Employment Support

Professional (CESP), Association of Community Rehabilitation Educators (ACRE), or Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation in lieu of competency requirements for supported employment staff in the CL, FIS, and BI Waivers.

In Chapter 4 clarifying language has been added to the following sections:

  • Supported Employment – clarity on assessments and follow-along supports;
  • Private Duty Nursing – clarification added regarding proposed nursing hours;
  • Residential and Companion Services – additional information on companion services; and
  • Services Facilitation – clarification related to training.

 

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

KEPRO

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

For credentialing and behavioral health service information, visit:

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

Call: 1-800-424-4046

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

Aetna Better Health of Virginia

www.aetnabetterhealth.com/Virginia

 1-800-279-1878

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-800-901-0020

Magellan Complete Care of Virginia

www.MCCofVA.com

 1-800-424-4518 (TTY 711) or 1-800-643-2273

Optima Family Care

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

and www.myuhc.com/communityplan

1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711), www.virginiapremier.com