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The purpose of this bulletin is to inform you of a temporary 12.5% rate increase for select HCBS services in accordance with the Acts of Assembly, 2021 Special Session II, Item E.1. HCBS includes specific waiver services, behavioral health services, home health services, Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services, and other services in compliance with CMS guidance.  A list of eligible procedure and revenue codes for the temporary rate increase are in the table below. The temporary rate increase is not applicable to school services, any customized rates, inpatient services, and rates paid under individual consideration. All services billed for using the procedure and revenue codes listed in the table below are eligible for the 12.5% temporary rate increase for dates of service on or after July 1, 2021 through June 30, 2022. This change will be effective October 8, 2021 for claims billed on or after this date. For claims billed and adjudicated prior to this date, please refer to the “Retrospective Claims” section within this document. Agency-directed and consumer-directed personal care, respite, and companion services will receive the temporary HCBS rate increase until December 31, 2021, when a 12.5% permanent rate increase will be implemented. This action is in accordance with the 2021 Appropriations Act as amended in the Virginia General Assembly Special Session II.

Managed Care Organizations (MCO) and Behavioral Health Services Administrator (BHSA) Magellan will implement these changes on a prospective basis by October 22nd, 2021.  This means that claims with dates of service on or after October 22 will include the increase.  See "Retrospective Claims" for claims billed and adjudicated prior to this date.

Procedure codes marked with an asterisk (*) have services and rates that will be effective December 1, 2021. Rates, rate increases, and specific procedure codes effective December 1, 2021 are subject to change. Existing services and service rates listed in the table above are subject to claims payment processing procedures and may not result in increased payments when not used for HCBS as outlined by federal and state guidance.

Retrospective Claims

The Department of Medical Assistance Services (DMAS) is working with our partners at the Centers for Medicare & Medicaid Services (CMS), the MCOs, Behavioral Health Services Administrator (BHSA) Magellan, and other State vendors to determine options for the State to adjust previously billed and adjudicated claims with dates of services between July 1, 2021 and October 7, 2021.  The State is seeking options to alleviate provider burden and will share subsequent information in a bulletin once federal guidance has been obtained.

Temporary HCBS Rate Update

New rates will be posted on the DMAS website at the following locations:

• Waiver rates can be found at https://www.dmas.virginia.gov/for-providers/long-term-care/waivers/ under “CCC Plus Waiver Rates” and “Developmental Disabilities Waiver Rates”.
• Behavioral health and ARTS rates are posted at https://www.dmas.virginia.gov/for-providers/addiction-and-recovery-treatment-services/information-and-provider-map/ under the “ARTS and Behavioral Health HCBS Rate Increases” link.

Mental Health service rates can be found at: https://www.dmas.virginia.gov/for-providers/behavioral-health/

• Home Health rates can be found at https://www.dmas.virginia.gov/for-providers/rate-setting/  under “Home Health”.
• Service rates that are not published under a specific program or waiver rate sheet can be checked by using our code search webpage at https://www.dmas.virginia.gov/for-providers/procedure-fee-files-cpt-codes/. Procedure codes that start with a number can use our “Search CPT codes” function. Procedure codes that start with a letter need to be searched manually in our “HCPC Codes” file.
• DMAS COVID-19 Response information can be found at https://www.dmas.virginia.gov/covid-19-response/

Temporary HCBS Rate Increase

This bulletin serves as the official notification that the temporary rates are posted on the DMAS website at http://www.dmas.virginia.gov/. Please use the contact information listed below if you have any questions or concerns.

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