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2016 Memos and Bulletins

Issue Date Title To:
19-Dec-16 Developmental Disabilities (DD) Waivers Redesign Implementation Clarification All Support Coordinators/Case Managers and Providers of Community Living (CL), Family and Individual Supports (FIS) and Building Independence (BI) Waiver Services
19-Dec-16 Sponsored Residential Service Changes for the Community Living Waiver - Effective 1/1/2017 All Providers of Sponsored Residential Services
2-Dec-16 Virginia 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-16 Implementation 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, 2016 All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-Dec-16 Long 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, 2017 All Acute Care Facilities, All Providers, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
9-Nov-16 Clarification of Existing Medicaid Coverage of Diabetic Retinopathy Screening via Telemedicine - Effective December 1, 2016 All Providers and Managed Care Organizations Participating in the Virginia Medicaid Program
2-Nov-16 Clarification 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 Glucose All Providers, Durable Medical Equipment Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
31-Oct-16 Pharmacy Fee-for-Service Reimbursement Methodology-Effective January 9, 2017 All Pharmacy Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
31-Oct-16 Commonwealth Coordinated Care Plus The DMAS Managed Long Term Services and Supports Program - Update REVISED All Providers Participating in the Virginia Medicaid Program and FAMIS Program
27-Oct-16 BabyCare Case Management Services Authorization Process All BabyCare Providers in the Virginia Medicaid Medical Assistance Services Programs, Managed Care Organizations (MCOs)
19-Oct-16 Changes 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, 2016 All Providers Participating in the Virginia Medicaid Program and FAMIS Program
4-Oct-16 DMAS 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, 2016 All Providers, Pharmacies and Managed Care Organizations Participating in the Virginia Medical Assistance Program
8-Sep-16 Changes for Crisis Support Services in the Development Disability Waivers All 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-16 Service Authorization for the Developmental Disabilities (DD) Waivers and the New Waiver Management System (WaMS): Intellectual Disability Online System (IDOLS) Replacement All Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFSDD) and Day Support (DS) Waiver Services in Virginia Medicaid
1-Sep-16 Updated Orientation and Competency Requirements for Direct Support Professionals and their Supervisors/Trainers All Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waiver Services in Virginia Medicaid
30-Aug-16 Virginia Independent Clinical Assessment Program (VICAP) All Organizations Medicaid Enrolled Behavioral Health Providers and Managed Care
30-Aug-16 Provider Enrollment Process Changes and Information for the Developmental Disabilities (DD) Waivers Effective September 1, 2016 All Providers of Intellectual Disability (ID), Individual and Family Developmental Disabilities Support (IFDDS) and Day Support (DS) Waiver Services
22-Aug-16 Medicaid Pharmacy Coverage of Insect Repellent – Effective August 22, 2016 All Providers, Pharmacies and Managed Care Organizations Participating in the Virginia Medical Assistance Program
10-Aug-16 Notice of DMAS Addiction and Recovery Treatment Services Transformation - Effective April 1, 2017 All Providers and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
1-Aug-16 Delay 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 waivers All Providers that Furnish Home and Community-Based Services (HCBS) and Commonwealth Coordinated Care Managed Care Plans
26-Jul-16 Occurrence Code 50 Billing Edit All Nursing Facility and Hospice Providers Participating in the Virginia Medical Assistance Program and Commonwealth Coordinated Care (CCC) Managed Care Plans
19-Jul-16 Coverage of Behavioral Therapy (Including Applied Behavioral Analysis) for FAMIS Managed Care Enrolled Members – Effective September 1, 2016 All Providers of Behavioral Health Services, Physicians, Nurse Practitioners, Magellan of Virginia, Managed Care Organizations (MCOs)
19-Jul-16 New Report for Nursing Facilities on eDocMgmt All Nursing Facility Providers
30-Jun-16 Rate 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 - REVISED All 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-16 Establishment of a Single Point of Entry for DD Waivers and Changes in Support Coordination/Case Management All 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-16 Removal of Adult Day Care Center (ADCC) Licensure Requirement from PACE Sites Serving Only PACE Participants - Effective July 1, 2016 All Programs of All Inclusive Care for the Elderly (PACE) Organizations within the Commonwealth of Virginia
30-Jun-16 Changes to Community Mental Health Rehabilitative Services - Final Regulations Pertaining to Mental Health Skill Building Services, Crisis Intervention, and Crisis Stabilization - Effective August 1, 2016 Providers of Community Mental Health Rehabilitative Services, Magellan Health of Virginia, and Managed Care Organizations
28-Jun-16 Behavioral and Medical Nursing Support Service Changes for Developmental Disability Waivers - Effective August 1, 2016 All 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-16 Delayed Implementation of Redesigned Developmental Disabilities Waivers Providers 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-16 Day Service Changes for Developmental Disabilities Waivers - REVISED All 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-16 Enhanced Ambulatory Patient Group (EAPG) for Outpatient Hospital Services; New Weights, Base Rates, and EAPG Grouper Version for Claims Payment - Effective July 1, 2016 All Hospitals and Managed Care Organizations Participating in the Virginia Medical Assistance Program
21-Jun-16 Changes to the Technology Assisted Waiver Program - Effective August 1, 2016 All Technology Assisted Waiver Providers Participating in the Virginia Medical Assistance Program
16-Jun-16 Governor’s Access Plan for Individuals with Serious Mental Illness (GAP) – Change in Financial Eligibility Requirements - Effective July 1, 2016 All Providers in the Virginia Medical Assistance Program
7-Jun-16 FY17 Nursing Facility and Specialized Care Rate Changes All Nursing Facility Providers Participating in the Virginia Medicaid Assistance Program
1-Jun-16 Drug Utilization Review (DUR) Board Approved Drug Service Authorization (SA) Requirements and Virginia Medicaid Preferred Drug List (PDL) Program Changes - Effective July 1, 2016 All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-Jun-16 Consumer Directed Waiver Services Providers 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-16 Residential Service Changes for Developmental Disability Waivers All Providers of Intellectual Disability, Individual and Family Developmental Disabilities Support (DD) and Day Support Waiver Services
24-May-16 Developmental Disabilities Medicaid Waivers Redesign All Providers of Intellectual Disability, Individual and Family Developmental Disabilities Support and Day Support Waiver Services
24-May-16 Inflation for Home Health Rates Effective July 1, 2016 All Providers of Home Health Services participating in the Virginia Medical Assistance Programs
24-May-16 Inflation for Outpatient Rehabilitation Rates Effective July 1, 2016 All Providers of Outpatient Rehabilitation services participating in the Virginia Medical Assistance Programs
19-May-16 Managed Long Term Services and Supports (MLTSS) Initiative All Providers and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
18-May-16 Notification That Keystone Peer Review Organization (KEPRO) Will No Longer Accept Service Authorization Requests for DD Waiver Services - Effective July 1, 2016 All Enrolled Support Coordinators/Case Managers and Service Providers for Individual and Family Developmental Disabilities Services (DD) Waiver
17-May-16 Transition of All DD Service Authorization Operations to DBHDS - Effective July 1, 2016 All Case Managers/Support Coordinators and Servicing Providers of Individual and Family Developmental Disabilities Supports (DD) Home and Community Based Waiver Services
26-Apr-16 New Regulations for Consumer Directed Services Facilitation – Effective January 11, 2016 - REVISED All 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-16 New Regulations for Consumer Directed Services Facilitation All 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-16 New Plan First ID Card Mailing Schedule - 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
11-Feb-16 Clarification of Medicaid Coverage of Physician Administered Drugs and Devices Providers Billing for Behavioral Health Services including all Community Service Boards