End of COVID-19 Flexibilities: Vaccines and Testing Effective October 1, 2024

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Bulletin

September 12, 2024, 1:10PM

To:

All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program

From:

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

The purpose of this bulletin is to inform providers of the changes to COVID-19 vaccines and COVID-19 testing policies based on the September 30, 2024, end to federal funding for COVID-19 flexibilities. These changes apply to all DMAS fee-for-service (FFS) and all contracted managed care organizations.

Effective October 1, 2024, DMAS will continue to reimburse all ACIP approved commercially available COVID-19 vaccines. The enhanced $40 vaccine administration fee for pharmacy providers will be discontinued. Vaccine administration fee will be reimbursed at our customary rate for all providers.
Effective October 1, 2024, DMAS will no longer reimburse COVID-19 at home, self swab testing products. Rapid COVID-19 tests and Polymerase chain reaction (PCR tests) COVID-19 tests will be covered by providers as listed below:

SELF SWAB COVID-19 TESTS

RAPID and PCR COVID-19 TESTS

At home

Pharmacies

Medical Providers

YES

FQHC

YES

Clinics

YES

*The Federal government will resume offering up to four free at-home COVID-19 test using the COVIDtests.gov website in late September 2024.

3. Currently Lagevrio is an investigational drug without FDA approval, Without FDA approval, Lagevrio will not be covered under the Medicaid pharmacy or medical benefit.

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://vamedicaid.dmas.virginia.gov/sa

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373

Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com

Provider HELPLINE