Updates to the Home and Community Based Services (HCBS) Developmental Disability Waivers Manual
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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.
The manual has been posted here:
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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 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 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |