2017 Memos and Bulletins
| Issue Date | Title | To: |
| 29-Dec-17 | Commonwealth Coordinated Care Plus Managed Care Program-Coordination with Medicare | All Providers Participating in the Virginia Medicaid and FAMIS Programs |
| 15-Dec-17 | Clarification of Authorization Policies for EPSDT Private Duty Nursing, Personal/Attendant Care and EPSDT School-Based Private Duty Nursing for All Medicaid Fee-for-Service Members | All Providers of EPSDT Private Duty Nursing, EPSDT School Based MCO Carve Out Private Duty Nursing, EPSDT Personal/Attendant Care Services and Managed Care Organizations Participating in the Virginia Medical Assistance Program |
| 15-Dec-17 | Transition of Certain Medallion 3.0 Beneficiaries to CCC Plus, Effective January 1, 2018 | All Providers Participating in the Virginia Medicaid and FAMIS Programs |
| 1-Dec-18 | Virginia Medicaid Preferred Drug List (PDL) Program Changes Including Hepatitis C Drug Changes, Effective January 1, 2018 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 <7/span> |
| 30-Nov-17 | Commonwealth Coordinated Care Program - Close Out | All Providers Participating in the Virginia Medicaid Program and FAMIS Program |
| 3-Nov-17 | Clarifying and Updating DMAS Coverage of Stem Cell Transplants Based on the Current Medical Standard of Care | All Providers Participating in the Virginia Medicaid and FAMIS Programs, Medicaid Managed Care Organizations |
| 25-Oct-17 | Reimbursement Clarification for Tetanus, Diphtheria, and Pertussis (Tdap) and Flu Vaccines for Pregnant Women Ages 21 and Over Enrolled in Medicaid Fee- for-Service | All Providers, Pharmacies, and Managed Care Organizations Participating in the Virginia Medicaid Program |
| 23-Oct-17 | Transitioning Community Mental Health Rehabilitation Services (CMHRS) into the CCC Plus Program | All Community Mental Health and Rehabilitation Service Providers, Behavioral Therapy Providers, Residential Treatment Services Providers, Magellan Healthcare of Virginia, and Managed Care Organizations |
| 16-Oct-17 | Governors Access Plan (GAP) for Individuals with Serious Mental Illness - Change in Financial Eligibility Requirements and Additional Covered Benefits | All Fee-for-Service Behavioral Health Providers in the Virginia Medical Assistance Program |
| 12-Oct-17 | Clarification on Residential Levels of Care in the Addiction and Recovery Treatment Service (ARTS) Benefit | All Substance Use Disorder Providers, Managed Care Organizations (MCOs) and Magellan of Virginia Participating in the Virginia Medical Assistance Program |
| 12-Oct-17 | Enhancements to Long-Term Services and Supports (LTSS) Electronic Screening System (ePAS) | Medicaid Long-Term Services and Supports (LTSS) Screening Entities (Community-Based and Hospital Teams) and LTSS Providers (Commonwealth Coordinated Care Plus (CCC Plus) Waiver Providers, Nursing Facilities, CCC Plus Health Plans), CCC Program, Fee-for-Services (FFS) Providers, Hospitals; and Managed Care Organizations |
| 4-Oct-17 | Reimbursement for Individuals Evacuated from a Disaster Struck Nursing Facility Due to Temporary Emergencies | All Long Term Care Providers Participating in the Virginia Medical Assistance Program and Managed Care Organizations (Health Plans) |
| 3-Oct-17 | Statewide Base Rate Correction for Ambulatory Surgical Centers Under Enhanced Ambulatory Patient Groups (EAPG) Payment Methodology | Ambulatory Surgical Centers Participating in the Virginia Medical Assistance Program and Virginia Medicaid Managed Care Organizations (MCOs) |
| 29-Sep-17 | Enhancements to Virginia Medicaid Direct Data Entry (DDE) for Claims Submissions, Effective October 28, 2017 | All Providers Participating in the Virginia Medical Assistance Programs |
| 27-Sep-17 | Magellan Medicaid Administration as DMAS New Pharmacy Benefit Administrator, Effective October 1, 2017 | All Prescribing Providers and Pharmacists Participating in the Virginia Medical Assistance Programs |
| 8-Sep-17 | Delay in Implementation of Early Periodic Screening and Diagnostic Treatment (EPSDT) Service Authorizations in Developmental Disabilities (DD) Waivers | All Providers of Developmental Disabilities (DD) Waiver Services, Support Coordination/Case Management services, EPSDT Private Duty Nursing, and EPSDT Personal/Attendant Care Services |
| 5-Sep-17 | New Medicare Card Replacement Initiative | All Providers Participating in the Virginia Medicaid and FAMIS Programs |
| 1-Sep-17 | Customized Rate for the Developmental Disabilities (DD) Waivers and Corrections to the Emergency Regulations | All Support Coordinators/Case Management Agencies and Providers of Developmental Disabilities (DD) Waivers services |
| 25-Aug-17 | Pending Update to the Durable Medical Equipment and Supplies Provider Manual - Chapter IV | 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 |
| 23-Aug-17 | FAMIS MOMS Coverage of Peer Services | All Providers Participating in the Virginia Medical Assistance Program, Magellan of Virginia and Managed Care Organizations |
| 18-Aug-17 | Improving Newborn Enrollment into the Virginia Medicaid Program Through The DMAS Provider Portal - Effective September 5, 2017 | Acute Care Hospitals and Certified Professional Midwives |
| 17-Aug-17 | Commonwealth Coordinated Care Plus (CCC Plus) Managed Care Program - CCC Plus Program Member Status and Exclusions for the Program of All- Inclusive Care for the Elderly and Certain Nursing Facilities | All Providers of Long-Term Services and Supports, Acute Care Hospitals (Hospital Screeners), Rehabilitation Hospitals (Hospital Screeners), Local Departments of Social Services (Community Based Screeners), Local Health Departments (Community Based Screeners) and Managed Care Plans |
| 26-Jul-17 | EPSDT Services and DD Waivers: Effective August 1, 2017 | Developmental Disabilities (DD) Waiver Services Providers |
| 19-Jul-17 | Revised Launch of Commonwealth Coordinated Care Plus Waiver - Effective July 1, 2017 | All Medicaid Enrolled Providers of Home and Community-Based Waiver Services and Pre-Admission Screening Teams |
| 17-Jul-17 | DMAS Comprehensive Response to the Opioid Addiction Crisis in Virginia | All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program |
| 17-Jul-17 | Implementation of Common Core Formulary in the Commonwealth Coordinated Care Plus (CCC Plus) Managed Care Program - Effective August 1, 2017 | All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program |
| 10-Jul-17 | Commonwealth Coordinated Care Plus (CCC Plus) Managed Care Program- Update | All Providers Participating in the Virginia Medicaid and FAMIS Programs |
| 30-Jun-17 | Notification of Updates to certain EPSDT Service Authorization Forms for Fee-for-Service and Managed Care members and Transition of Clinical Reviews of Certain EPSDT Fee-for-Service Authorizations from KEPRO to DMAS Medical Support Unit or DBHDS - effective August 1, 2017 | All Providers of EPSDT Private Duty Nursing, EPSDT School Based MCO Carve Out Private Duty Nursing, EPSDT Personal/Attendant Care Services and Managed Care Organizations Participating in the Virginia Medical Assistance Program, DBHDS, VACSB, DD Waiver Service Facilitators and Case Managers. |
| 13-Jun-17 | Provider Medical Record Documentation of Covered Services: Change in Timing Requirements for Provider Signatures | All Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program |
| 9-Jun-17 | Hospital Reimbursement Payments: Effective July 1, 2017 | All Hospitals and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program |
| 9-Jun-17 | Inflation for Outpatient Rehabilitation Rates: Effective July 1, 2017 | All Providers of Outpatient Rehabilitation Services Participating in the Virginia Medical Assistance Program and Medicaid Managed Care Organizations (MCOs) |
| 9-Jun-17 | Fee-For-Service Home Health and DME Face-to-Face Encounter Requirements | Home Health Providers and Durable Medical Equipment and Supplies (DME) Providers; Ordering, Referring and Prescribing Providers, Physicians and Practitioners |
| 8-Jun-17 | Implementation of Uniform, Streamlined Prior Authorization for Short and Long Acting Opioids Aligned with Virginia Board of Medicine Regulations Governing Prescribing of Opioids - Effective July 1, 2017 | All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program |
| 8-Jun-17 | Drug Utilization Review (DUR) Board-Approved Drug Service Authorization (SA) Requirements and Virginia Medicaid Preferred Drug List (PDL) Program Changes-Effective July 1, 2017. | All Prescribing Providers, Pharmacists, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program |
| 8-Jun-17 | New Medicaid Coverage for Peer Support Services and Family Support Partners: Effective July 1, 2017 (Revised)* | All Providers, Medallion 3.0 Managed Care Organizations, Commonwealth Coordinated Care Medicare and Medicaid Plans, Magellan of Virginia |
| 6-Jun-17 | Launch of Commonwealth Coordinated Care (CCC) Plus Waiver - Effective July 1, 2017 | All Medicaid Enrolled Providers of Home and Community-Based Waiver Services and Pre-Admission Screening Teams |
| 1-Jun-17 | How to Receive Notice of and Submit Comments on DMAS Manual and Regulatory Changes | All Medicaid, FAMIS, and FAMIS MOMS Providers |
| 1-Jun-17 | Inflation for Home Health Rates Effective July 1, 2017 | All Providers of Home Health Services Participating in the Virginia Medical Assistance Program and Medicaid Managed Care Organizations (MCOs) |
| 1-Jun-17 | New Program Manual for Residential Treatment Services and Changes to the Independent Certification of Need Process | All Psychiatric Service Providers, Acute Care and Psychiatric Hospitals, Level C Residential Treatment Facilities, Level A and Level B Group Homes, EPSDT Residential Treatment Providers, Magellan and Managed Care Organizations |
| 1-Jun-17 | New Medicaid Coverage for Peer Support Services and Family Support Partners: Effective July 1, 2017 |
All Providers, Medallion 3.0 MEDICAID MEMO Managed Care Organizations, Commonwealth Coordinated Care Medicare and Medicaid Plans , Magellan of Virginia |
| 25-May-17 | Updates to the Optima Contacts on the ARTS Service Authorization Forms and Case Management Registration Form – Effective May 11, 2017 | All Providers, Managed Care Organizations, Commonwealth Coordinated Care Medicare and Medicaid Plans |
| 25-May-17 | Mandatory 2017 Provider Self-Assessment for Compliance with the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) Settings Regulations | All Providers of Group Home Residential Services, Sponsored Residential Services, Supported Living Services, Group Day Services and Group Supported Employment Services available in the Developmental Disabilities (DD) Waivers |
| 12-May-17 | Implementation of 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 Community Living (CL), Building Independence (BI), or Family and Individual Supports (FIS) Home and Community Based Waivers; Community Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID); and Nursing Facilities Providing Services to Individuals with Developmental Disabilities |
| 8-May-17 | New Rates and RUG Grouper Version Change for Nursing Facility Claim Payments Effective July 1, 2017 | All Providers of Nursing Facility and Specialized Care Services and Nursing Facility-Based Hospice Services; Commonwealth Coordinated Care (CCC) Demonstration Plans and CCC Plus Managed Care Plans |
| 26-Apr-17 | Revised Patient Pay Payment Processing for Claims Submitted by Providers of Long-Term Services and Supports in the Month of Transition from Nursing Facility to Elderly or Disabled with Consumer Direction (EDCD) Waiver - Effective April 1, 2017 | Providers of Nursing Facility Services and Services in the Elderly or Disabled with Consumer Direction Waiver |
| 28-Mar-17 | Reimbursement Rates for Addiction and Recovery Treatment Services (ARTS) - Effective April 1, 2017 - REVISED | Behavioral Health Services Providers and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program |
| 27-Mar-17 | Changes from the Chief Medical Officer Regarding CPT and HCPCS Code Coverage and Service Authorization for Dates of Service on or after April 1, 2017 for the Medicaid Fee-for-Service Program- Update REVISED | All Providers and Managed Care Organizations Participating in the Virginia Medicaid Program |
| 27-Mar-17 | Commonwealth Coordinated Care Plus Program- Update REVISED | All MEDICAID MEMO Providers Participating in the Virginia Medicaid Program and FAMIS Program |
| 27-Mar-17 | Medicaid Coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) – Effective January 1, 2017 REVISED | All Providers, MEDICAID MEMO Acute Care Hospitals, Imaging Centers Organizations Participating in the Virginia M and Managed Care edical Assistance |
| 15-Mar-17 | New Addiction and Recovery Treatment Services Provider Manual | All Providers, Managed Care Organizations, Commonwealth Coordinated Care Medicare and Medicaid Plans |
| 23-Feb-17 | Changes from the Chief Medical Officer Regarding CPT and HCPCS Code Coverage and Service Authorization for Dates of Service on or after April 1, 2017 for the Medicaid Fee-for-Service Program | All Providers MEDICAID MEMO and Managed Care Organizations Medicaid Program |