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2007 Memos and Bulletins

Issue Date Title To:
26-Dec-07 Plan First-The Medicaid Fee-For-Service Family Planning Waiver Program - Eligible Population, Enrollment, Covered Services, Service Limits and Billing Requirements as well as Upcoming Training Dates - Effective January 1, 2008 All Medical Doctors, Nurse Practitioners, Professional Midwives, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Pharmacies, Outpatient Clinics and Managed Care Organizations Participating in the Virginia Medical Assistance Program
20-Dec-07 Prior Authorization - Outpatient Substance Abuse Services that will Transition to KePRO for Fee-for-Service Enrollees - Effective January 1, 2008 All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Clinical Psychologists, Psychiatric Nurse Practitioners, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
11-Dec-07 Children's Mental Health Program - Effective December 1, 2007 All Potential Providers of the Children's Mental Health Program, Psychiatric Residential Treatment Facilities, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program
4-Dec-07 Changes to Enhanced Prospective Drug Utilization Review Programs and Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program Effective January 1, 2008 All Pharmacy and Medical Providers Participating in the Virginia Medical Assistance Programs
19-Oct-07 Outpatient Substance Abuse Services that require Prior Authorization for Fee-for-Service Enrollees All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Psychologists, Clinical Psychologists, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Residential Inpatient Facilities, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
19-Oct-07 Updates and Clarification of the Prior Authorization Process for Outpatient Services All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
11-Oct-07 Medicaid Enrollment and Coverage of Certified Professional Midwives All Virginia Licensed Certified Professional Midwives, Medical Doctors, Nurse Practitioners, Nurse Midwives, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Outpatient Clinics, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program
9-Oct-07 Changes to the Prior Authorization and Billing Process for Psychiatric Residential Treatment and Treatment Foster Care - Effective October 1, 2007 All Psychiatric Residential Treatment Providers, Treatment Foster Care Case Management Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons
9-Oct-07 Prior Authorization Updates - Waivers ? Effective Immediately All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
3-Oct-07 Delayed Implementation of Tamper Resistant Prescription Pad Requirements Now Effective April 1, 2008 All Pharmacy, Medical Providers, Dental Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
2-Oct-07 Discontinuation of Legacy Automated Response System (ARS) Access All Providers Participating in the Virginia Medical Assistance Program
12-Sep-07 Virginia Medicaid Healthy ReturnsSM Disease Management Program Expanded to Include Chronic Obstructive Pulmonary Disease (COPD) Effective May 1, 2007 All Providers (with the exception of Dentists) and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Programs
5-Sep-07 Implementation of Tamper-Resistant Prescription Pad Requirements - Effective October 1, 2007 All Pharmacy, Medical Providers, Dental Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
30-Aug-07 Update to Second Edition of the Durable Medical Equipment and Supplies Provider Manual All Durable Medical Equipment and Supplies providers participating in the Virginia Medical Assistance Program, Managed Care Organizations, and holders of the Durable Medical Equipment and Supplies Provider Manual.
27-Aug-07 Provider Education for the Hospital Utilization Review Audit Process All Inpatient Acute and Inpatient Psychiatric Service Providers.
23-Aug-07 Early Periodic Screening Diagnosis and Treatment (EPSDT) Screening and Developmental Assessments Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Providers and DMAS-Enrolled Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
8-Aug-07 Integration of Acute and Long Term Care Services - Phase I All Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations (Excluding Dental Providers).
1-Aug-07 Enrollment of Additional Specialties of Licensed Nurse Practitioners - Effective August 1, 2007 Physicians, Nurse Practitioners, Clinical Nurse Specialists, Nurse Midwives, Hospitals, State Mental Hospitals, Private Mental Hospitals, Residential Treatment/Treatment Foster Care Facilities, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, School Health Clinics,Outpatient Clinics, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Programs
31-Jul-07 Provider Satisfaction Survey for Prior Authorization Services All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers; All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers; All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services; All Home and Community Based Care Waiver Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
13-Jul-07 New Rates and Processing of Emergency Room Physician Claims - Effective July 1, 2007 Emergency Room Physicians Participating in the Virginia Medical Assistance Program and Managed Care Organizations providing services to Virginia Medicaid Recipients
5-Jul-07 Expansion of Managed Care Services in Lynchburg - Effective October 1, 2007 All Providers (with the exception of Dentists) and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Programs
26-Jun-07 Increase in the Personal Needs Allowance for Institutionalized Individuals Residing in Nursing Facilities and in Intermediate Care Facilities for the Mentally Retarded (ICF-MR) - Effective July 1, 2007 All State Mental Hospitals, Long Stay Hospitals, Skilled Nursing Home Mental Health Facilities, Medical Surgery Facilities serving the Mentally Retarded, Skilled Nursing Homes, Skilled Nursing Facilities, Long Stay Inpatient Hospitals, Mental Health Medical Surgery Facilities, and Intermediate Care Facilities participating in the Virginia Medicaid Program.
12-Jun-07 Medicaid Coverage of Substance Abuse Services - Effective July 1, 2007 All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Psychologists, Clinical Psychologists, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Residential Inpatient Facilities, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
7-Jun-07 BabyCare Rate Changes - Effective July 1, 2007 All Providers of Maternal Infant Care Coordination (MICC) services participating in the Virginia Medical Assistance Programs, including Physicians, Nurse Practitioners, Nurse Midwives, Health Department Clinics, Federally Qualified Health Centers, Rural Health Clinics, Department of Social Service, Case Management Providers, Prenatal Nutritionists, Private Home Health Agencies and Community Service Boards, and High Risk Maternity and Infant Program Managers of the Medicaid Managed Care Organizations (MCOs).
5-Jun-07 Physician Rate Increases - Effective July 1, 2007 All Physicians participating in the Virginia Medical Assistance Program, FAMIS, and Managed Care Organizations providing services to Virginia Medicaid and FAMIS recipients.
5-Jun-07 Rate Increase for Personal Care and Related Services - Effective July 1, 2007 All Personal Care and Related Services Providers.
5-Jun-07 Northern Virginia Rate Differential for MR, DD, and Day Support Waiver Services - Effective July 1, 2007 Mental Retardation (MR), Individual and Family Developmental Disabilities Support (DD) and Day Support Waiver Providers programs.
31-May-07 New National Drug Code (NDC) Billing Requirement for Drug-Related HCPCS J-Codes - Effective July 1, 2007 All Prescribing Physician Providers Participating in the Virginia Medical Assistance Programs.
31-May-07 Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program, Enhanced Prospective Drug Utilization Review Programs, National Provider Identifier (NPI) Dual Use Extension, and Pharmacy Web-Based Prior Authorization Process All Pharmacy and Prescribing Medical Providers Participating in the Virginia Medical Assistance Programs.
8-May-07 National Provider Identifier (NPI) Update: DMAS Dual Use Period Extended Beyond May 23, 2007 and Paper Claim Form Deadline (June 1, 2007) All Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations.
23-Apr-07 Changes to the Prior Authorization Request Form for Intensive In-Home Services All Intensive In-Home Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
23-Apr-07 Changes to the Prior Authorization Process for Psychiatric Residential Treatment All Psychiatric Residential Treatment Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons.
19-Apr-07 New Questionnaires Available to Facilitate Waiver Services Requests for Prior Authorization All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
19-Apr-07 Northern Virginia Rate Differential for MR, DD, and DS Waivers - Effective July 1, 2007 Mental Retardation (MR) Waiver, Individual and Family Developmental Disabilities Support (DD)Waiver, and Day Support (DS) Waiver providers.
19-Mar-07 NPI Update: DMAS Requirements for National Taxonomy Codes for Home Health, Private Duty, and Atypical Service Providers Virginia Medicaid Participating Home Health, Private Duty Nursing, Personal Care, Respite, Adult Day Health, Assisted Living, MH-MR Services, Case Management Waiver, Family Caregiver Training, and Treatment Foster Care Providers.
12-Mar-07 Changes to the Prior Authorization Process for Treatment Foster Care Case Management - Effective March 1, 2007 All Treatment Foster Care Case Management Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons.
21-Feb-07 General Billing Instructions for the New CMS-1450 (UB-04) - Effective April 1, 2007 All Providers Billing on the CMS-1450 (UB-04) Form.
14-Feb-07 Updates and Clarification of the Prior Authorization Process for Inpatient Services All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs Assistance Programs.
14-Feb-07 Updates and Clarification of the Prior Authorization Process for Outpatient Services - February 14, 2007 All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
9-Feb-07 Atypical Provider Identifier (API) Update: DMAS Dual Use Period - March 26 - May 22, 2007 - March 26 - May 22, 2007 Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations.
9-Feb-07 National Provider Identifier (NPI) Update: DMAS Dual Use Period - March 26 - May 22, 2007 Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations.
31-Jan-07 Baby Care Mileage Rate Increase - Effective February 1, 2007 All Providers of Maternal Infant Care Coordination (MICC) services participating in the Virginia Medical Assistance Programs, including Health Department Clinics, Federally Qualified Health Centers, Rural Health Clinics, Department of Social Service, Case Management Providers, Private Home Health Agencies and Community Service Boards.
31-Jan-07 Changes to Treatment Foster Care Case Management Reimbursement - Effective March 1, 2007 Providers of Treatment Foster Care Case Management
19-Jan-07 New Web Site for the Automated Response System (ARS) and National Provider Identifier (NPI) Compliance for the ARS - Effective February 19, 2007 All Providers Participating in the Virginia Medical Assistance Program
10-Jan-07 Updates and Clarification of the Prior Authorization Process for Community Based Care Services All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
10-Jan-07 Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
10-Jan-07 Updates and Clarification of the Prior Authorization Process for Outpatient Services -January 10, 2007 All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
10-Jan-07 Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management, Residential Treatment Services, and Intensive In-Home Services All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services and Managed Care Organizations Participating in the Virginia Medical Assistance Programs