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2015 Memos and Bulletins

Note: Most Memos and Bulletins for 2015 are only available in PDF format


Issue Date Title To:
17-Dec-15 Medicaid Reimbursement Rate Changes for Hospice Services–Effective January 1, 2016 All Providers of Hospice Services Participating in the Virginia Medical Assistance Programs
15-Dec-15 Enhanced Ambulatory Patient Group (EAPG) for Ambulatory Surgical Centers; New Weights, Base Rate, and EAPG Grouper Version for Claims Payment Effective January 1, 2016 Enhanced Ambulatory Patient Group (EAPG) for Ambulatory Surgical Centers; New Weights, Base Rate, and EAPG Grouper Version for Claims Payment
14-Dec-15 Information for Providers on the Proposed Transition from CCC to MLTSS All Providers Participating in the Virginia Medical Assistance Services Program
11-Dec-15 Plan First Gets A New Look - Effective March 1, 2016 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
3-Dec-15 Requirement for Valid ICD-10 Diagnosis for All Claims - Effective 10/1/2015 All Providers of Long Term Care and Transportation Services
1-Dec-15 Fee-For-Service Medicaid/FAMIS/FAMIS MOMS: Coverage of Lactation Services - Effective January 1, 2016 All Physicians, Nurse Practitioners, Professional Midwives, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Durable Medical Equipment (DME) providers (In-state and Out-of-state) and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
30-Nov-15 Consumer Directed Waiver Services - Employer of Record Changes - Effective January 1, 2016 Services Facilitation Providers for EDCD, DD, ID, and for the EPSDT Program
19-Nov-15 Virginia Medicaid Preferred Drug List (PDL) Program Changes Effective January 1, 2016, Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA) Requirements and Coverage of Over-the-Counter (OTC) drugs All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
12-Nov-15 Court of Appeals Decision in 1st Stop Health Services v. DMAS All Providers Participating in the Virginia Medical Assistance Program
14-Oct-15 Required CCC Merged Member Satisfaction and Quality of Life Surveys All Providers Participating in the Virginia Medical Assistance Commonwealth Coordinated Care (CCC) Program
13-Oct-15 Notification That KEPRO Will Accept Mass Volume Requests to Change Authorizations from Atypical Provider IDs (APIs) to National Provider IDs (NPIs) - Effective Immediately All Enrolled Providers for Elderly or Disabled with Consumer Direction (EDCD) Waiver Participating with Medicare-Medicaid Plans (MMPs) for Commonwealth Coordinated Care (CCC)
5-Oct-15 Medicaid Reimbursement Rate Changes for Hospice Services - Effective October 1, 2015 All Providers of Hospice Services Participating in the Virginia Medical Assistance Programs
2-Sep-15 Revised Patient Pay Payment Processing for Claims Submitted by Providers of Long-Term Services and Supports Except Those Providing Supports Under the Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waivers - Effective October 1, 2015 Providers of Long-Term Care Services
31-Aug-15 Medicaid Reimbursement Rate Changes for Home Health Services in Culpeper and Rappahannock Counties - Effective July 1, 2015 All Providers of Home Health Services Participating in the Virginia Medical Assistance Programs
25-Aug-15 Implementation of ICD-10 Diagnosis and Procedure Codes for All DMAS Providers - Effective October 1, 2015 All Providers in the Virginia Medical Assistance Program
1-Jul-15 Governor's Access Plan for the Seriously Mentally Ill (GAP) Eligibility Changes - Effective May 15, 2015 All Providers in the Virginia Medical Assistance Program
15-Jun-15 Implementation of Provider Paperless Communications - Effective August 3, 2015 All Billing Providers Participating in the Virginia Medical Assistance Programs
15-Jun-15 Notification that KEPRO is Converting to Electronic Process for Submitting Service Authorization Requests - Effective September 1, 2015 All Providers Enrolled as Hospitals, Elderly or Disabled with Consumer Direction (EDCD) Waiver; Money Follows the Person (MFP), Technology Assisted (Tech) Waiver, Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services (Private Duty Nursing, Personal Care and Attendant Care and MCO Carve Out School Services); Support Coordinators for Individual and Family Developmental Disabilities Support (DD) Waiver; Durable Medical Equipment and Supplies; and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
3-Jun-15 Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA) Requirements and Virginia Medicaid Preferred Drug List (PDL) Program Changes - Effective July 1, 2015; and DMAS’ Policy on Medicaid Coverage of Physician Administered Drugs and Devices All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
3-Jun-15 New Requirements for Providers of the Commonwealth Coordinated Care Program All Atypical Providers Enrolled in the Virginia Medical Assistance Program &
Medicare/Medicaid Plans
3-Jun-15 Processing of Emergency Room Physician Claims - Effective July 1, 2015 Emergency Room Physicians Participating in the Virginia Medical Assistance Program Providing Services to Virginia Medicaid Recipients
3-Jun-15 Interim Instructions for Waiver Providers in Use of API (Atypical Provider Identification) vs NPI (National Provider Identification) and Changes to KEPRO’s Service Authorization Process and Impact on Provider Services - Effective July 1, 2015 All Medicaid Enrolled Providers of Outpatient Rehabilitation Services, Physicians, Elderly and Disabled with Consumer Direction (EDCD) Waiver, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
18-May-15 Implementation of RUG-Adjusted Rates for Hospice Services Furnished to Nursing Facility Residents - Effective July 1, 2015 All Providers of Hospice Services and Nursing Facility Services
15-May-15 Virginia Governor’s Access Plan for the Seriously Mentally Ill (GAP) - Pharmacy Services All Pharmacy Providers in the Virginia Medical Assistance Program
4-May-15 Rate Changes for Home and Community Based Services and EPSDT Nursing and Personal Care/Respite Services - Effective July 1, 2015 All Providers of Home and Community-Based Services and Nursing and Personal Care/ Respite Services in the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and Managed Care Organizations
17-Apr-15 Electronic Pre-Admission Screening (ePAS) Process Providers of Long-Term Care Services and Acute Care Hospitals
25-Mar-15 Delay of New Patient Pay Payment Processing for Claims Submitted by Long-Term Care Providers Providers of Long-Term Care Services
9-Mar-15 Changes to Community Mental Health Rehabilitative Services - Final Regulations Pertaining to all Community Based Services with the Exception of Mental Health Skill-Building Services Providers of Community Mental Health Rehabilitative Services, Magellan Health of Virginia, and Managed Care Organizations
6-Mar-15 Clarifications to the EPSDT Behavioral Therapy Manual All Providers of Behavioral Health Services
27-Jan-15 Dental Coverage for Medicaid Enrolled Adult Pregnant Women and FAMIS MOMS - Effective March 1, 2015 Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations, Except Dental
9-Jan-15 Automation of the Pre-Admission Screening (PAS) Process All Providers of Pre-Admission Screenings Participating in the Virginia Medical Assistance Program and Managed Care Organizations
18-Jan-15 Provider Assessment of Settings - To Be Completed By January 31, 2015 All Providers of Residential Support, Day Support, Prevocational and Group Supported Employment services through the Intellectual Disability (ID), Day Support (DS) and Individual and Families Developmental Disabilities Support (DD) Waivers
7-Jan-15 Commonwealth Coordinated Care (CCC) Waiver Quality Assurances Required for CCC EDCD Enrollees by the Center for Medicare and Medicaid Services - Effective December 1, 2014 All Providers of the Elderly or Disabled With Consumer Directed (EDCD) Waiver Participating in Virginia Medical Assistance Program and Managed Care Organizations