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2016 Memos and Bulletins

Important Notice:  Provider Memos and Bulletins issued prior to 2020 will no longer be available for download from this website.  These Memos and Bulletins are still available by request directly from DMAS.  To request a memo or bulletin from 2020 or earlier, please email the MES document team here: dezari.johnson@dmas.virginia.gov

Listings of memos and bulletins for years prior to 2020 are still available.  Please  include the Title and Issue Date when making your email request.

Issue DateTitleTo:
19-Dec-16Developmental Disabilities (DD) Waivers Redesign Implementation ClarificationAll Support Coordinators/Case Managers and Providers of Community Living (CL), Family and Individual Supports (FIS) and Building Independence (BI) Waiver Services
19-Dec-16Sponsored Residential Service Changes for the Community Living Waiver - Effective 1/1/2017All Providers of Sponsored Residential Services
2-Dec-16Virginia Medicaid Preferred Drug List (PDL) Program Changes including Hepatitis C Drug Changes Effective January 1, 2017 and Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA)All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-Dec-16Implementation of CDC Guideline for Prescribing Opioids for Chronic Pain - Coverage of Non-Opioid Pain Relievers and Uniform, Streamlined Prior Authorization for New Opioid Prescriptions Effective December 1, 2016All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-Dec-16Long Acting Reversible Contraceptives (LARC) Payment in an Inpatient Hospital for Members in Medicaid and FAMIS Fee-for-Service Programs and Managed Care Organizations-Effective for Dates of Service on or after January 1, 2017All Acute Care Facilities, All Providers, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
9-Nov-16Clarification of Existing Medicaid Coverage of Diabetic Retinopathy Screening via Telemedicine - Effective December 1, 2016All Providers and Managed Care Organizations Participating in the Virginia Medicaid Program
2-Nov-16Clarification Monitoring (CGM) for Members in Medicaid/FAMIS/FAMIS MOMS Fee-for- Service Programs - Effective for Dates of Service On or After December 15, 2016 - REVISED of Existing Medicaid Coverage of Continuous GlucoseAll Providers, Durable Medical Equipment Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
31-Oct-16Pharmacy Fee-for-Service Reimbursement Methodology-Effective January 9, 2017All Pharmacy Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
31-Oct-16Commonwealth Coordinated Care Plus The DMAS Managed Long Term Services and Supports Program - Update REVISEDAll Providers Participating in the Virginia Medicaid Program and FAMIS Program
27-Oct-16BabyCare Case Management Services Authorization ProcessAll BabyCare Providers in the Virginia Medicaid Medical Assistance Services Programs, Managed Care Organizations (MCOs)
19-Oct-16Changes to the Service Authorization (SA) of Organ and Stem Cell Transplants and Non-Emergency, Outpatient, Out of State MRI, PET and CAT Scans - Effective November 1, 2016All Providers Participating in the Virginia Medicaid Program and FAMIS Program
4-Oct-16DMAS Fee for Service Pharmacy Program's Additions to the Enhanced Prospective Drug Utilization Review (ProDUR) Program (Dose Optimization) and Discontinuation of Coverage for Ketamine in Topical Compounds - Effective November 1, 2016All Providers, Pharmacies and Managed Care Organizations Participating in the Virginia Medical Assistance Program
8-Sep-16Changes for Crisis Support Services in the Development Disability WaiversAll Providers of Services for Individuals in the Redesigned Developmental Disabilities (DD) Waivers: Community Living (CL), Family and Individual Supports (FIS), and Building Independence (BI) Waivers
1-Sep-16Service Authorization for the Developmental Disabilities (DD) Waivers and the New Waiver Management System (WaMS): Intellectual Disability Online System (IDOLS) ReplacementAll Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFSDD) and Day Support (DS) Waiver Services in Virginia Medicaid
1-Sep-16Updated Orientation and Competency Requirements for Direct Support Professionals and their Supervisors/TrainersAll Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waiver Services in Virginia Medicaid
30-Aug-16Virginia Independent Clinical Assessment Program (VICAP)All Organizations Medicaid Enrolled Behavioral Health Providers and Managed Care
30-Aug-16Provider Enrollment Process Changes and Information for the Developmental Disabilities (DD) Waivers Effective September 1, 2016All Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waiver Services
22-Aug-16Medicaid Pharmacy Coverage of Insect Repellent – Effective August 22, 2016All Providers, Pharmacies and Managed Care Organizations Participating in the Virginia Medical Assistance Program
10-Aug-16Notice of DMAS Addiction and Recovery Treatment Services Transformation - Effective April 1, 2017All Providers and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
1-Aug-16Delay of the Implementation of Redesigned Development Disabilities Waivers and Rate increases Effective July 1, 2016 for Personal Care, Respite Care, Companion Care, Adult Day Health Care, In-Home Residential Support, Skilled Nursing and Private Duty Nursing Services for individuals in HCBS waiversAll Providers that Furnish Home and Community-Based Services (HCBS) and Commonwealth Coordinated Care Managed Care Plans
26-Jul-16Occurrence Code 50 Billing EditAll Nursing Facility and Hospice Providers Participating in the Virginia Medical Assistance Program and Commonwealth Coordinated Care (CCC) Managed Care Plans
19-Jul-16Coverage of Behavioral Therapy (Including Applied Behavioral Analysis) for FAMIS Managed Care Enrolled Members – Effective September 1, 2016All Providers of Behavioral Health Services, Physicians, Nurse Practitioners, Magellan of Virginia, Managed Care Organizations (MCOs)
19-Jul-16New Report for Nursing Facilities on eDocMgmtAll Nursing Facility Providers
30-Jun-16Rate Increases for Personal Care, Respite Care, Companion Care, Adult Day Health Care and Private Duty Nursing Services for Members in Home and Community Based Services Waivers and the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program - REVISEDAll Providers that Furnish Services for Personal Care, Respite Care, Companion Care, Adult Day Health Care and Private Duty Nursing and Managed Care Programs
1-Jul-16Establishment of a Single Point of Entry for DD Waivers and Changes in Support Coordination/Case ManagementAll Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waiver Services in the Virginia Medical Assistance Program
30-Jun-16Removal of Adult Day Care Center (ADCC) Licensure Requirement from PACE Sites Serving Only PACE Participants - Effective July 1, 2016All Programs of All Inclusive Care for the Elderly (PACE) Organizations within the Commonwealth of Virginia
30-Jun-16Changes to Community Mental Health Rehabilitative Services - Final Regulations Pertaining to Mental Health Skill Building Services, Crisis Intervention, and Crisis Stabilization - Effective August 1, 2016Providers of Community Mental Health Rehabilitative Services, Magellan Health of Virginia, and Managed Care Organizations
28-Jun-16Behavioral and Medical Nursing Support Service Changes for Developmental Disability Waivers - Effective August 1, 2016All Providers of Services for Individuals in the Intellectual Disability, Individual and Family Developmental Disabilities Support (DD) and Day Support Waivers in the Virginia Medical Assistance Program
23-Jun-16Delayed Implementation of Redesigned Developmental Disabilities WaiversProviders of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waiver Services in the Virginia Medical Assistance Program
22-Jun-16Day Service Changes for Developmental Disabilities Waivers - REVISEDAll Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (DD) and Day Support (DS) Waiver Services in the Virginia Medical Assistance Program
21-Jun-16Enhanced Ambulatory Patient Group (EAPG) for Outpatient Hospital Services; New Weights, Base Rates, and EAPG Grouper Version for Claims Payment - Effective July 1, 2016All Hospitals and Managed Care Organizations Participating in the Virginia Medical Assistance Program
21-Jun-16Changes to the Technology Assisted Waiver Program - Effective August 1, 2016All Technology Assisted Waiver Providers Participating in the Virginia Medical Assistance Program
16-Jun-16Governor’s Access Plan for Individuals with Serious Mental Illness (GAP) – Change in Financial Eligibility Requirements - Effective July 1, 2016All Providers in the Virginia Medical Assistance Program
7-Jun-16FY17 Nursing Facility and Specialized Care Rate ChangesAll Nursing Facility Providers Participating in the Virginia Medicaid Assistance Program
1-Jun-16Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA) Requirements and Virginia Medicaid Preferred Drug List (PDL) Program Changes - Effective July 1, 2016All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-Jun-16Consumer Directed Waiver ServicesProviders of Services Facilitation Services, Personal Care and Case Management for the Elderly or Disabled with Consumer Direction, Intellectual Disability, Individual and Family Developmental Disabilities Waivers and Early Periodic Screening Diagnosis and Treatment (EPSDT) Program, and Medicaid Works
31-May-16Residential Service Changes for Developmental Disability WaiversAll Providers of Intellectual Disability, Individual and Family Developmental Disabilities Support (DD) and Day Support Waiver Services
24-May-16Developmental Disabilities Medicaid Waivers RedesignAll Providers of Intellectual Disability, Individual and Family Developmental Disabilities Support and Day Support Waiver Services
24-May-16Inflation for Home Health Rates Effective July 1, 2016All Providers of Home Health Services participating in the Virginia Medical Assistance Programs
24-May-16Inflation for Outpatient Rehabilitation Rates Effective July 1, 2016All Providers of Outpatient Rehabilitation services participating in the Virginia Medical Assistance Programs
19-May-16Managed Long Term Services and Supports (MLTSS) InitiativeAll Providers and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
18-May-16Notification That Keystone Peer Review Organization (KEPRO) Will No Longer Accept Service Authorization Requests for DD Waiver Services - Effective July 1, 2016All Enrolled Support Coordinators/Case Managers and Service Providers for Individual and Family Developmental Disabilities Services (DD) Waiver
17-May-16Transition of All DD Service Authorization Operations to DBHDS - Effective July 1, 2016All Case Managers/Support Coordinators and Servicing Providers of Individual and Family Developmental Disabilities Supports (DD) Home and Community Based Waiver Services
26-Apr-16New Regulations for Consumer Directed Services Facilitation – Effective January 11, 2016 - REVISEDAll Service Facilitation Providers participating in the Virginia Medical Assistance Programs such as the Elderly or Disabled with Consumer Directed Services, Intellectual Disability, and Developmental Disabilities Waivers and the EPSDT Program
15-Apr-16New Regulations for Consumer Directed Services FacilitationAll Service Facilitation Providers participating in the Virginia Medical Assistance Programs such as the Elderly or Disabled with Consumer Directed Services, Intellectual Disability, and Developmental Disabilities Waivers and the EPSDT Program
23-Feb-16New Plan First ID Card Mailing Schedule - Effective March 1, 2016All 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
11-Feb-16Clarification of Medicaid Coverage of Physician Administered Drugs and DevicesProviders Billing for Behavioral Health Services including all Community Service Boards