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2021 Memos and Bulletins

Issue DateTitleTo:
30-Dec-21COVID-19 Vaccine Administration by Pharmacists, Pharmacy Interns, and Pharmacy Technicians under the Federal PREP Act Declaration and its AmendmentsAll Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Organizations Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs, and Managed Care Organizations
30-Dec-21Inter-Rater Reliability Study of LTSS ScreeningsLong Term Services and Supports (LTSS) Screening Teams; Hospitals, Nursing Facilities and Community Based Screening Teams Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs, and Managed Care Organizations
17-Dec-21One-time COVID-19 Support Payment for Attendant/AidesAll Providers of Personal Care, Attendant/Aide Care, Respite Care, and Companion Care Services for the Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs, and Managed Care Organizations
16-Dec-21Mandatory Medicaid Coverage of Routine Patient Costs Furnished in Connection with Participation in Qualifying Clinical TrialsAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
14-Dec-21One-time COVID-19 Support Payment for Attendant/AidesAll Providers of Personal Care, Attendant/Aide Care, Respite Care, and Companion Care Services for the Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs, and Managed Care Organizations
10-Dec-21Coverage of gender dysphoria servicesAll Providers Participating in the Virginia Medicaid and FAMIS Programs, all Medicaid Managed Care Organizations
10-Dec-21Federal Vaccination RequirementAll Medicaid Providers and Managed Care Organizations
1-Dec-21Project BRAVO: Behavioral Health Redesign for Access, Value & Outcomes, New Enhanced Behavioral Health Services, Effective December 1, 2021 and Applied Behavior AnalysisAll Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Fee-for-Service Contractor (Magellan of Virginia)
23-Nov-21Federal Vaccination RequirementAll Medicaid Providers and Managed Care Organizations
23-Nov-21Update: Janssen (Johnson & Johnson), Moderna COVID-19 and Pfizer COVID-19 Vaccine BoostersAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
22-Nov-21Direct Support Professional (DSP) and Supervisor Orientation TestAll Providers Developmental Disability (DD) Waiver Services
19-Nov-21Coverage of Pfizer COVID-19 Vaccination, Members Aged 5-11All Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
19-Nov-21Face-To-Face Supervisory and Case Management VisitsAll Providers of Personal Care, Attendant/Aide Care, Respite Care, and Companion Care Services for the Early Periodic Screening, and Diagnosis and Treatment (EPSDT), Developmental Disability Waivers (DDW), Commonwealth Coordinated Care (CCC) Plus Waiver programs, DMASContracted Managed Care Organizations, Department of Behavioral Health Developmental Services (DBHDS), and Virginia Department of Health (VDH)
18-Nov-21Civil Monetary Penalty (CMP) Reinvestment Program Funding OpportunityAll Long-Term Care Providers Participating in the Virginia Medical Assistance Program and Managed Care Organizations (Health Plans)
9-Nov-21Updated coverage of COVID-19 Antibody Products & COVID-19 Vaccine Home AdministrationAll Providers Participating in the Virginia Medicaid and FAMIS Programs
1-Nov-21One-time COVID-19 Support Payment for Attendant/AidesAll Providers of Personal Care, Attendant/Aide Care, Respite Care, and Companion Care Services for the Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs, and Managed Care Organization
28-Oct-21COVID-19 Federal Public Health Emergency Extended Until January 16, 2022All Providers Participating in the Virginia Medicaid and FAMIS Programs
19-Oct-21Coverage of Additional COVID Vaccine Dose for Certain Immunocompromised IndividualsAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS ProgramsVirginia)
13-Oct-21Update to the Enrollment of Afghan ImmigrantsAll Hospital Providers Participating in Virginia’s Medicaid and FAMIS Programs
6-Oct-21Temporary Home and Community Based Services (HCBS) rate update effective July 1, 2021Providers of Home and Community Based Services Waivers (HCBS) and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
5-Oct-21Eligibility of Pregnant Individuals at the End of their Postpartum PeriodAll Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Organizations
1-Oct-21Coverage of Pfizer COVID-19 Vaccine Administration BoosterAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
24-Sep-21Enrollment of Afghan ImmigrantsAll Hospital Providers Participating in Virginia’s Medicaid and FAMIS Programs
10-Sep-21Medicaid Fee-For-Service Enrollment of Physician Assistants and Nurse Practitioners Practicing as Certified Registered Nurse AnesthetistsAll Virginia Licensed Physicians, Physician Assistants, Nurse Practitioners and Certified Registered Nurse Anesthetists, and Managed Care Organizations participating in the Virginia Medicaid and FAMIS Programs
25-Aug-21Provider Appeals For Medicaid Members - Reminder that Authorization Is RequiredAll Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Organizations
25-Aug-21Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital during the Federal Public Health Emergency due to COVID-19 RequiredHospitals, Managed Care Organizations (MCOs), and Magellan of Virginia Participating in the Virginia Medical Assistance Program
20-Aug-21Allowance of licensed school psychologists as outpatient psychiatric services providersAll Behavioral Health Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
1-Aug-21Addition of buprenorphine/naloxone tab SL to the Virginia Common Core Formulary/Preferred Drug ListAll Prescribers and Providers of Pharmacy Services Participating in the Virginia Medical Assistance Program, Managed Care Organizations Providing Services to Virginia Medicaid Recipients
14-Jul-21Update of Coverage of Routine ContraceptivesAll Providers and Managed Care Organizations Participating in the Virginia Medicaid, FAMIS, and Plan First Programs
13-Jul-21Psychiatric Residential Treatment Facilities, Medallion 4.0 and Commonwealth Coordinated Care (CCC) Plus Managed Care PlansResidential Treatment Facility Rate Changes - Effective July 1, 2021
1-Jul-21Skilled and Private Duty Nursing Rate Update effective July 1, 2021Providers of Home and Community Based Services Waivers (HCBS) and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
1-Jul-21Project BRAVO: Behavioral Health Redesign for Access, Value & Outcomes, New Enhanced Behavioral Health Services, Effective December 1, 2021 and Applied Behavior AnalysisAll Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Fee-for-Service Contractor (Magellan of Virginia)
1-Jul-21Update on claims processing for Temporary Home and Community Based Services (HCBS) rate update effective July 1, 2021Providers of Home and Community Based Services Waivers (HCBS), Home Health, Behavioral Health, Early Intervention and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid
1-Jul-21Funding for Psychiatric Residential Treatment Facilities (PRTF) Placements and new and updated forms for Children's Services Act (CSA) Referrals and Transfer of Jurisdiction for Residential Treatment Services (effective date 7/1/2021)All Residential Treatment Services, Local Children’s Services ACT (CSA) Programs, Locals Departments of Social Services
1-Jul-21Dental Coverage for Medicaid Enrolled Adults (21 years of age and older) Effective July 1, 2021Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations, Except Dental
1-Jul-21Skilled and Private Duty Nursing Rate Update effective July 1, 2021Providers of Home and Community Based Services Waivers (HCBS) and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
1-Jul-21Updates to Coverage of COVID-19 TestingAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
1-Jul-21Durable Medical Equipment and Supplies Rate FloorAll Durable Medical Equipment and Supplies providers participating in the Virginia Medical Assistance Program, Managed Care Organizations
1-Jul-21Nursing Facility and Specialized Care Rate Updates Effective July 1, 2021Nursing Facility, Specialized Care, and Hospice Service Providers; Commonwealth Coordinated Care (CCC) Plus Managed Care Plans
1-Jul-21Clarifications of Registration Requirements Covering Peer Recovery Support Services for Medicaid Members – Effective July 1, 2021.All Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
1-Jul-21Coverage of Substance Use Disorder (SUD) Treatment Services in Institutions for Mental Diseases (IMD) Settings for FAMIS MOMS MembersAll Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
1-Jul-21Hospital Reimbursement - Effective July 1, 2021All Hospitals and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
1-Jul-21Professional Services Rate Increases - Effective July 1, 2021Professional Services Providers and Medicaid Managed Care Organizations (MCOs)
1-Jul-21Inflation for Home Health Rates Effective July 1, 2021All Providers of Home Health Services participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
1-Jul-21Inflation for Outpatient Rehabilitation Rates, Effective July 1, 2021All Providers of Outpatient Rehabilitation Services Participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
30-Jun-21Developmental Disabilities (DD) Waivers Rate Updates Effective July 1, 2021All Providers of Developmental Disabilities (DD) Waivers Services
30-Jun-21COVID Flexibilities Update – Expiration of State PHE on 6/30/2021All Medicaid Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
28-Jun-21Coverage of COVID-19 Vaccine Administration for Plan FirstAll Medicaid Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
11-Jun-21New FAMIS Prenatal Coverage for Pregnant Individuals Previously Ineligible Due to Immigration StatusAll Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Organizations
11-Jun-21Dental Coverage for Medicaid Enrolled Adults (21 years of age and older) Effective July 1, 2021 Due to Immigration StatusVirginia Medicaid Participating Healthcare Providers and Managed Care Organizations, Except Dental
11-Jun-21Employment and Community Transportation (ECT)All Providers Developmental Disability (DD) Waiver Services
1-Jun-21Changes to the enforcement of requirements related to Ordering, Referring and Prescribing (ORP) provider enrollment and screeningLocal Education Agencies (School Divisions) Participating in the Virginia Medical Assistance Program
10-May-21Information Regarding DMAS Client Appeals (State Fair Hearing)All Virginia Medicaid Providers, Members, and Managed Care Organizations
7-May-21Project BRAVO: Behavioral Health Redesign for Access, Value & Outcomes, Reimbursement Rates for New Enhanced Behavioral Health Services Effective July 1, 2021 and the new Mental Health Services Manual (Formerly Community Mental Health Rehabilitation ServiAll Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
1-May-21Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care Update Effective May 1, 2021Providers of Home and Community Based Services Waivers (HCBS) and Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) services, Program of All Inclusive Care for the Elderly (PACE), participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
30-Apr-21Allowance of Preferred Office-Based Opioid Treatment (OBOT) Services Delivery via Mobile UnitsPreferred Office Based Opioid Treatment (OBOT) Programs, Managed Care Organizations (MCOs), and Magellan of Virginia Participating in the Virginia Medical Assistance Program
28-Apr-21United States Department of Health and Human Services updated practice guidelines for the prescribing of buprenorphine.All Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
21-Apr-21Updates to Coverage of COVID-19 Testing & Antibody TreatmentAll Providers Participating in the Virginia Medicaid and FAMIS Programs
22-Apr-21COVID-19 Flexibility Updates Through July 20, 2021All Providers Participating in the Virginia Medicaid and FAMIS Programs
22-Apr-21Department of Behavioral Health and Developmental Services (DBHDS) Amendments to 12VAC35-105 and 12VAC35-46 for Behavioral Health Enhancement and American Society of Addiction Medicine (ASAM) Levels of Care Criteria - Service Modifications Processing StarAll Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
1-Apr-21Update for Lawful Permanent Residents: 40 Work Quarter Requirement Removed OrganizationsAll Medicaid Providers and MCOs ("MCOs")
1-Apr-21Update to Reimbursement Rate for COVID-19 Vaccine Administration OrganizationsAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs ("MCOs")
11-Mar-21Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19All Providers of Home and Community Based Services Waivers (HCBS) and Early Periodic Screening, Diagnosis, and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
9-Mar-21Information Regarding Contract Requirements for Medicaid Managed Care OrganizationsAll Virginia Medicaid Providers, Members, and Managed Care Organizations ("MCOs")
5-Mar-21COVID-19 Flexibility Updates Through 4/20/2021 Redesign for Access, Value & OutcomesAll Providers Participating in the Virginia Medicaid and FAMIS Programs
2-Mar-21Coverage of Single-Dose COVID-19 Vaccine AdministrationAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
2-Mar-21Enhanced Behavioral Health Services / Project BRAVO: Behavioral Health Redesign for Access, Value & OutcomesAll Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
24-Feb-21Update to Reimbursement Rate for COVID-19 Antigen TestingAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
8-Feb-21Updates to Coverage of High-Throughput COVID-19 TestingAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
14-Jan-21COVID-19 Flexibility Continuations Until 4/20/2021All Medicaid Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
11-Jan-21Implementation of Medicaid Long Term Services and Supports (LTSS) Screening Conducted by Nursing FacilitiesMedicaid Long Term Services and Supports (LTSS) Screening Agencies (Community Based Teams, Hospitals and Nursing Facilities); other State Agencies involved in the Screening Process: Department for Aging and Rehabilitative Services (DARS); Program of All Inclusive Care for the Elderly (PACE); Medicaid Managed Care Organizations (MCOs) and other public partners affected by Medicaid LTSS Screening Process
7-Jan-21Electronic Visit Verification Live-In Caregiver Exemption and Consumer-Directed Personal Care OvertimeServices Facilitation Providers, Agency Personal Care Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
5-Jan-21Pharmacy Procedure For COVID-19 VaccineAll Medicaid Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
4-Jan-21Update Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19All Providers of Home and Community Based Services Waivers (HCBS) and Early Periodic Screening, Diagnosis, and Treatment (EPSDT) services participating in Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
1-Jan-21Developmental Disabilities (DD) Waivers Rate Changes Effective January 1, 2021All Providers of Developmental Disabilities (DD) Waivers Services