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The purpose of this memorandum is to notify providers of changes to the Residential Treatment Services Manual. In addition to clarifications to existing language the following changes were made:

• References to qualified mental health professionals (QMHPs) were updated to reflect updates to § 54.1-3500 of the Code of Virginia, updated Virginia Board of Counseling regulations (18VAC115-80) and guidance available at: Board of Counseling - QMHP Information.

• QMHP-trainee supervisor requirements were updated to reflect updated Virginia Board of Counseling requirements. 

• Language related to Cardinal Care Managed Care (CCMC) enrollment for youth in PRTFs was updated in accordance with Item 288.LLLLL in the 2025 Appropriation Act: 

“The Department of Medical Assistance Services shall amend the state plans under Titles XIX and XXI of the Social Security Act, and any waivers thereof, and make any changes to managed care contracts as necessary to enable children served in psychiatric residential treatment facilities (PRTF) to maintain their enrollment in managed care during their treatment. The payment for PRTF per diem payments and PRTF required services shall be carved out of managed care and paid as a fee-for-service benefit. Required services include assessment and diagnosis, physician medication management and supervision, urine testing and psychological professional services when delivered by facility staff or contractors. Any service eligible for reimbursement through the Children's Services Act shall not be included in managed care. The department shall have the authority to create a new capitation payment structure to reflect this change in managed care service delivery. Costs associated with any carved-out services shall be excluded from managed care payment methodologies. The department shall have the authority to implement this change effective July 1, 2025 and prior to the completion of any regulatory process.”

• Enrollment guidance for out of state PRTF providers was added to Chapter 2.

• An Independent Assessment Certification and Coordination Team (IACCT) exception was added for youth receiving treatment in a PRTF or Therapeutic Group Home who transfer to a Residential Crisis Stabilization Unit (RCSU).

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.