Extended Deadlines for 23-Hour Crisis Stabilization Providers to Obtain MH Center-Based Crisis Receiving Center License and Provider Enrollment Requirements for Comprehensive Crisis and Transition Services
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The purpose of this bulletin is to notify providers that DMAS has extended the deadlines previously announced in the August 13, 2024 DMAS bulletin “Department of Behavioral Health and Developmental Services (DBHDS) Crisis Services Regulatory Updates and Related Provider Enrollment Requirements for Comprehensive Crisis and Transition Services.” This bulletin provides updated information on deadlines for 23-Hour Crisis Stabilization providers to obtain the appropriate DBHDS license and properly enroll with DMAS. This bulletin includes detailed provider enrollment requirements for all providers of comprehensive crisis and transition services including Community Service Boards (CSBs) who only provide emergency services.
23-Hour Crisis Stabilization
DMAS requires all providers of 23-Hour Crisis Stabilization (S9485) services to obtain the MH Center-Based Crisis Receiving Center (CRC) for Adults (02-040) and/or MH Center-Based Crisis Receiving Center for Children and Adolescents (02-041) license by November 15, 2024. Additional information on the CRC license is available on the DBHDS Office of Licensing website: https://dbhds.virginia.gov/clinical-and-quality-management/office-of-licensing/.
DMAS requirements for 23-Hour Crisis Stabilization detailed in the Comprehensive Crisis and Transition Services Appendix G to the Mental Health Services Manual remain in effect. These requirements include, but are not limited to, 24/7 on-site provision of services and 24-hour on-site nursing.
The Mental Health Services Manual requires that all DBHDS licensed providers of Medicaid services adhere to DBHDS licensing rules as they relate to service provision. Additional details related to recent DBHDS regulatory changes are available on the DBHDS Office of Licensing webpage at https://dbhds.virginia.gov/clinical-and-quality-management/office-of-licensing/. DMAS will be updating the Mental Health Services Manual to align with these regulatory changes.
DMAS Provider Enrollment
DMAS, in coordination with DBHDS, is extending the deadline for providers of Mobile Crisis Response (H2011), 23-Hour Crisis Stabilization (S9485), Residential Crisis Stabilization Unit (RCSU) (H2018) and Community Stabilization (S9482) services to ensure that they are properly enrolled. The new deadline to enroll with DMAS in accordance with the chart below is December 2, 2024 by 5pm.
Service | DBHDS License | Provider Type | Provider Specialty | MOU or contract |
|---|---|---|---|---|
Mobile Crisis Response |
| 156 or 456 | 920 | All current MOU(s) or contract(s) must be on file in the DMAS Provider Enrollment System |
23-Hour Crisis Stabilization |
| 156 or 456 | 921 |
|
RCSU |
| 077 | 177 | n/a |
Community Stabilization |
| 156 or 456 | 902 | All current MOU(s) or contract(s) must be on file in the DMAS Provider Enrollment System |
Submission of Memorandums of Understanding (MOUs)
The following are clarifications to the requirement that providers of Mobile Crisis Response (H2011) and Community Stabilization (S9485) submit current, active State Fiscal Year 2025 and any subsequent updated MOUs or contracts with the regional crisis hubs through the DMAS Online Provider Enrollment System:
Providers (including all CSBs) that are not currently enrolled with the Mobile Crisis Response (920) and/or Community Stabilization (902) specialty and are initially enrolling with one or both of these specialties must upload MOUs or contracts in the DMAS Online Provider Enrollment System portal.
Providers (including all CSBs) that are currently enrolled with the correct specialties for Mobile Crisis Response and Community Stabilization must submit new and updated MOUs or contracts to Provider Enrollment Services by fax to 1-888-335-8476 or by e-mail to VAMedicaidProviderEnrollment@gainwelltechnologies.com.
CSBs who only provide emergency services pursuant to section §37.2-800 et. seq. and section §16.1-335 et seq. of the Code of Virginia must enroll as a Mobile Crisis Response provider with specialty 920 and submit a letter attesting that a MOU with the regional hub is not necessary as Mobile Crisis Response (H2011) is billed by the CSB for emergency services only. This letter can be uploaded during initial enrollment for Mobile Crisis Response or submitted to Provider Enrollment Services by fax to 1-888-335-8476 or by e-mail to VAMedicaidProviderEnrollment@gainwelltechnologies.com.
Providers that do not meet the December 2, 2024 deadline of ensuring they are properly enrolled will not be eligible to provide the service or be reimbursed by DMAS or its contractors until enrollment is complete and approved. DMAS MCOs may have additional steps that providers must complete before a provider is eligible for reimbursement. Please contact the MCO directly to determine whether additional requirements apply.
Questions?
Questions related to provider enrollments can be directed to Provider Enrollment Services at VAMedicaidProviderEnrollment@gainwelltechnologies.com or phone 1-888-829-5373.
Questions related to DBHDS regulations effect on licensing for crisis services can be directed to DBHDS at crisis_services@dbhds.virginia.gov
Questions related to DMAS provider requirements for crisis services can be sent to enhancedbh@dmas.virginia.gov
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.
Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | |
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. | |
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 | |
Provider Enrollment | In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
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 | https://www.aetnabetterhealth.com/virginia/providers/index.html 1-800-279-1878
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Anthem HealthKeepers Plus | 1-800-901-0020
|
Molina Complete Care
| 1-800-424-4524 https://www.molinahealthcare.com/providers/va/medicaid/home.aspx
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Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
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United Healthcare | 1-844-284-0149
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Dental Provider DentaQuest | 1-888-912-3456 |
Fee-for-Service (POS) Prime Therapeutics
| https://www.virginiamedicaidpharmacyservices.com/ 1-800-424-4046 |
Acentra Health Behavioral Health and Medical Service Authorizations | https://vamedicaid.dmas.virginia.gov/sa 1-804-622-8900 |