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2014 Memos and Bulletins

Note: Memos and Bulletins for 2014 are only available in PDF format


Issue Date Title To:
17-Dec-14 Reinstatement of FAMIS MOMS - Effective December 1, 2014 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
5-Dec-14 Virginia Medicaid Preferred Drug List (PDL) Program Changes Effective January 1, 2015, Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA) Requirements, DMAS’ Policy Medicaid Coverage of Physician Administered Drugs and Devices, Submission of Partial Fills for CII Drugs by Long-term Care Facilities, Provider Enrollment and Screening Requirements, and Submission of DAW9 Code All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
3-Dec-14 Virginia Governor’s Access Plan for the Seriously Mentally Ill (GAP) All Providers in the Virginia Medical Assistance Program
24-Oct-14 Exceptional Supports Reimbursement Rate - Effective November 1, 2014 All Providers of Congregate Residential Services (CRS) though the Intellectual Disability (ID) Waiver and Community Services Boards
7-Oct-14 Medallion 3.0 Change - MajestaCare Exiting the Western, Roanoke and Alleghany Regions - Effective December 1, 2014 All Providers and Managed Care Organizations (MCOs) Participating in the impacted localities/surrounding areas in the Virginia Medical Assistance Programs
7-Oct-14 New Regulations for Temporary Detention Orders (TDO’s) and Emergency Custody Orders (ECOs) Hospitals, Physicians, Laboratories, and Community Services Boards
1-Oct-14 Medicare Crossover Billing Instructions on the Paper CMS 1500 (02-12) Form - Effective November 2, 2014 All Providers Billing on the CMS -1500 (02-12) Form
26-Sep-14 Implementation of Nursing Facility Price-Based Payment - Effective November 1, 2014 All Providers of Nursing Facility Services
19-Sep-14 Health and Acute Care Program (HAP) - Effective December 1, 2014 All Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations
20-Aug-14 Inpatient Hospital Reimbursement Changes - Effective October 1, 2014 - APR-DRG Grouper All Hospitals and Managed Care Organizations Participating in the Virginia Medical Assistance Program
28-Jul-14 Commonwealth Coordinated Care Program Update All Providers Participating in the Virginia Medical Assistance Program
24-Jul-14 New Expedited Managed Care Enrollment Process for Medallion 3.0 Enrollees All Providers in the Virginia Medical Assistance Program and Managed Care Organizations
9-Jul-14 Nutritional Counseling for Children Under the Age of 21 and Pregnant Women - Service Unit Changes for CPT Codes 97802 and 97803 - Effective 4/1/2014 - REVISED All Providers of BabyCare Services Participating in the Virginia Medical Assistance Programs, Including Health Department Clinics, Federally Qualified Health Centers, Rural Health Clinics, Department of Social Services, Case Management Providers, Private Home Health Agencies and Community Service Boards, and High Risk Maternity and Infant Program Managers of the Medicaid Managed Care Organizations (MCOs)
2-Jul-14 Modify Durable Medical Equipment (DME) Rates to Match Medicare Competitive Bid Rates All Providers of Durable Medical Equipment
2-Jul-14 Rate Changes for Clinical Laboratory Services - Effective July 1, 2014 All Providers of Clinical Laboratory Services and Managed Care Organizations Participating in the Virginia Medical Assistance Program
2-Jul-14 No Inflation Adjustment for Outpatient Rehabilitation Agencies - Effective July 1, 2014 through June 30, 2016 All Medicaid Outpatient Rehabilitation Providers and Comprehensive Outpatient Rehabilitation Facilities (CORFs) Participating in the Virginia Medical Assistance Program, Managed Care Organizations, and Holders of the Rehabilitation Medicaid Provider Manual
2-Jul-14 No Inflation Adjustment for Home Health Providers - Effective July 1, 2014 All Home Health Providers Participating in the Virginia Medical Assistance Programs and Managed Care Organizations
25-Jun-14 Composition of Pre-Admission Screenings for Teams All Providers of Pre-Admission Screening Services Participating in the Virginia Medical Assistance Program, Managed Care Organizations, and Medicare/Medicaid Program
25-Jun-14 Implementation of Nursing Facility Price-Based Payment Methodology - REVISED All Providers of Nursing Facility Services
18-Jun-14 Beneficiary Choice in Health Care Decisions All Providers Participating in the Virginia Medical Assistance Program
11-Jun-14 National Drug Code (NDC) and Unit of Measure (UOM) Required for All Drug Related HCPCS Codes - Effective May 26, 2014 - REVISED All Physicians, Professional Practitioners, Renal Dialysis Units, Health Departments, FQHC’s, RHC’s, CSB’s, Durable Medical Equipment Providers, and Out of State Physicians Billing on the CMS-1500 (02/12) Form
9-Jun-14 New Requirements for Billing of Services Provided Under Arrangement Furnished to Medicaid Members Under the Age of 21 in Residential Treatment Centers - Level C or Freestanding Psychiatric Hospitals Residential Treatment Centers (Level C); Freestanding Psychiatric Hospitals that Provide Services to Individuals Under 21 Years of Age; General Acute Care Hospitals; Physicians; Licensed Psychologists; Clinical Psychologists; Licensed Professional Counselors; Clinical Nurse Specialists – Psychiatric Only; Nurse Practitioners – Psychiatric Only; State Health Department; Federally Qualified Health Center; Rural Health Clinic; Mental Health, Mental Retardation, Substance Abuse Clinics (FAMIS); Licensed Clinical Social Workers; Licensed Social Workers, Out-of-State Physicians; Licensed Marriage and Family Therapists; Substance Abuse Practitioners; Optometrists; Opticians; Nutritionists; Podiatrists; Audiologists; Hearing Aid Providers; Physical Therapists; Occupational Therapists; Speech-Language Pathologists; DME/Supply Providers; Prosthetics Providers; Independent Labs; Prescribing Providers; Pharmacists; Radiology Providers; Providers of MRIs; Respiratory Therapists; Ambulatory Surgical Centers; Emergency Transportation Providers; Transportation Providers; and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
5-Jun-14 Virginia Medicaid Preferred Drug List (PDL) Program Changes, Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA) Requirements - Effective July 1, 2014; DUR Service Authorization Requirements for Antipsychotics and DMAS’ Policy on Submission of 340B Pharmacy Claims All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
30-May-14 Medicaid Managed Care Program Name and Program Enhancements - Effective July 1, 2014 All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
20-May-14 Implementation on Quality Service Reviews (QSR) Pursuant to the Commonwealth’s Settlement Agreement with the U.S. Department of Justice (DOJ) All Providers of Services to Individuals Enrolled in the Intellectual Disability (ID), Day Support (DS), or Individual and Family Developmental Disabilities Supports (IFDDS or DD) Home and Community Based Waivers; Community Intermediate Facilities/Individuals with Intellectual Disability (ICFs/IID); and Nursing Facilities Providing Services to Individuals with Intellectual or Developmental Disabilities
20-May-14 ICD-10 Fee for Service - Testing All Fee for Service Providers Participating in the Virginia Medical Assistance Program
20-May-14 DD Case Management Training and Data Collection - Effective June 1, 2014 Providers of Case Management Services under the Individual and Family Developmental Disabilities Support (DD) Waiver
13-May-14 Updates to Telemedicine Coverage All Physicians, Nurse Practitioners, Clinical Psychologists, Clinical Nurse Specialists, Licensed Clinical Social Workers, Licensed Professional Counselors, Marriage and Family Therapists, Behavioral Health Services Providers, Nurse Midwives, Hospitals, Skilled Nursing Facilities, Intermediate Care Facilities, Renal Units, Health Department Clinics, Federally Qualified Health Centers, Rural Health Clinics, Community Services Boards, Substance Abuse Treatment Practitioner, Residential Treatment Centers-C, Local Education Agencies, School Psychologists and Managed Care Organizations Participating in the Virginia Medical Assistance Program
21-Apr-14 Ending of Service Authorization Requirements for Vision Codes - Effective May 1, 2014 All Ophthalmologists, Optometrists, Opticians, and Managed Care Organizations Providing Services to Virginia Medicaid Members
16-Apr-14 Update to Hospital Presumptive Eligibility - Effective April 28, 2014 All Medicaid Enrolled Hospitals
3-Apr-14 ID and DD Respite Service Authorizations - Effective April 1, 2014 Medicaid Enrolled Providers of Respite Services, Services Facilitators Through the Individual and Family Developmental Disabilities Waiver Services (DD) and Intellectual Disability (ID) Waivers, and ID and DD Case Managers
3-Apr-14 Molecular Pathology Codes No Longer Requiring a Service Authorization - Effective May 1, 2014 All Physicians, Independent Laboratories, and Hospitals Participating in the Virginia Medical Assistance Program
24-Mar-14 Notification of a Procedural Change for Annual Level of Care Reviews (LOCERI) for Waiver and PACE Participants and Policy Manual Updates - Effective May 1, 2014 All Home and Community Based Waiver Services Providers (Including Service Facilitators and Private Duty Nursing), Home Health Providers, Program for the All-Inclusive Care of the Elderly (PACE), and Managed Care Organizations Participating in the Virginia Medical Assistance Program
21-Mar-14 General Billing Instructions for the New CMS-1500 (02-12) Form - Effective April 1, 2014 All Providers Billing on the CMS -1500 (02-12) Form
7-Mar-14 Implementation of the CMS - Affordable Care Act Provider Enrollment and Screening Requirements All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
6-Mar-14 Medicare-Medicaid Financial Alignment Demonstration All Providers in the Virginia Medical Assistance Program
4-Mar-14 Respite Care Service Authorizations - Changes Effective March 1, 2014 Medicaid Enrolled Providers of Respite Services for the Elderly or Disabled with Consumer Direction Waiver and Technology Assisted Waiver
26-Feb-14 Procedure Change for the Pre-Admission Screening Process (PASRR) for Individuals Transferring from DBHDS State Facilities to Nursing Facilities - Effective March 1, 2014 Directors and Staff at Department of Behavioral Health and Developmental Services (DBHDS) Behavioral Health Facilities and Training Centers and Managed Care Organizations
3-Jan-14 Rate and Service Unit Changes for Skilled Nursing Services - Effective February 1, 2014 All Providers of Skilled Nursing Services in Home and Community Based Care Waivers