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2023 Memos and Bulletins

Issue DateTitleTo:
26-Dec-23Updates to Pharmacy Manual Chapter 4 and a New Supplement to the Pharmacy and Practitioner ManualsAll prescribing Providers, Pharmacists and Managed Care Organizations Participating in the Virginia Medical Assistance Program
26-Dec-23Personal Care Rate Update Effective January 1, 2024All Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
26-Dec-23Early Intervention Rate Update Effective January 1, 2024All Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
26-Dec-23Behavioral Health Service Rate Updates Effective January 1, 2024All Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
15-Dec-2312-Month Continuous Eligibility (CE) for Children – Implementation of Mandated Provision of the Consolidated Appropriations Act of 2023All Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
12-Dec-23All Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care ProgramsAll Providers and Managed Care Organizations
8-Dec-23Patient Pay Underpayments - UPDATEAll Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
7-Dec-23Update to Nursing Facility Manual – Chapters 7, 9, 10, and 11All Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Programs
7-Dec-23Update to Psychiatric Services Manual – Chapter 6All Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Programs
6-Dec-23Annual Service Plan Contractor for Fee-For-Service Individuals on the CCC Plus Waiver Effective 1/1/2024All Providers of Personal Care, Attendant/Aide Care, Respite Care, and Companion Care Services, Consumer-Directed Services Facilitators, and Adult Day Health Care Providers for Commonwealth Coordinated Care (CCC) Plus Waiver programs
1-Dec-23Announcement New Brain Injury Services Case Management Service Begins on January 1, 2024Case Management Services Providers; Managed Care Organizations Participating in Virginia Medicaid
1-Dec-23National Provider Identifier (NPI) requirement on Health Department Clinic claims for enteral formulaAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Program
27-Nov-23Coverage of Collaborative Care Management (CoCM) ServicesProviders and Medicaid Managed Care Organizations (MCOs)
16-Nov-23Update to Legally Responsible Individuals: Implementation Delayed to March 1, 2024All Providers of Personal Care, Attendant Care, Respite Care, and Companion Care Services for the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs
16-Nov-23Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project UpdateAll Home Health Providers, Services Facilitation Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Program
9-Nov-23Mobile Crisis Response (H2011) process changes effective December 15, 2023 per Department of Behavioral Health and Developmental Disabilities (DBHDS) Administrative Instructional MemoAll Providers of Behavioral Health Services, Acentra Health, Commonwealth Coordinated Care (CCC) Plus Managed Care Plans and Medallion 4 Managed Care Plans
30-Oct-23Coverage of RSV Vaccination & Preventive TreatmentAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
17-Oct-23Update on Changes for Long Term Services and Supports and Hospice Services Under Cardinal Care Managed Care (CCMC)All Long-Term Services and Supports (LTSS) and Hospice Providers, Contractors, and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
17-Oct-23General Update on Cardinal Care ℠ - Virginia’s Medicaid Program, Including Changes Under Cardinal Care Managed Care (CCMC)All Providers, Contractors, and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
6-Oct-23Delay of the Implementation of Brain Injury Services Case Management ServiceAll Service Providers, Contracted Managed Care Organizations and Contracted Service Administrators
29-Sep-23Update to Legally Responsible Individuals Rules Effective November 11, 2023All Providers of Personal Care, Attendant Care, Respite Care, and Companion Care Services for the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, Developmental Disability Waivers, Commonwealth Coordinated Care Plus Waiver programs; Co
18-Sep-23Provider Training on How to Register and Submit Successful Service Authorization Requests to Acentra Health (formerly known as Kepro) Effective November 1, 2023All Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
11-Sep-23Update to Transportation Manual Chapter 4All Providers Participating in the Virginia Medicaid and FAMIS Programs
30-Aug-23Deemed Newborns Automated ProcessAll Providers Participating in the Virginia Medicaid and FAMIS Programs
29-Aug-23Coverage During the 90-Day Enrollment Grace PeriodAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
28-Aug-23New Case Management Service for Persons with Traumatic Brain InjuryCase Management Services Providers and Contracted Managed Care Organizations
28-Aug-23Update to Physician-Practitioner Manual, Chapters 4 and 5; and Hospital Manual, Chapter 5All Providers Participating in the Virginia Medicaid and FAMIS Programs
21-Aug-23Updates to the Comprehensive Crisis and Transition Services - Appendix (Appendix G) of the Mental Health Services ManualAll Providers of Behavioral Health Services, Magellan of Virginia, Commonwealth Coordinated Care (CCC) Plus Managed Care Plans and Medallion 4 Managed Care Plans
17-Aug-23Minimum Data Set (MDS) changes effective October 1, 2023Nursing Facility, Specialized Care, and Hospice Service Providers; Commonwealth Coordinated Care (CCC) Plus Managed Care Organizations (MCO)
17-Aug-23Changes to Claims/Payment Process for Behavioral Health Providers- effective November 1, 2023All Behavioral Health Services Administrator (BHSA) Providers
16-Aug-23Managed care plans to assist enrollees in completing the Medicaid renewal processAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
2-Aug-23Update to Addiction and Recovery Treatment Services (ARTS) Manual Chapters 2, 4, and 6, and Preferred Office-Based Addiction Treatment and Opioid Treatment Program (OBAT-OTP) SupplementAll Providers Participating in the Virginia Medicaid and FAMIS Programs
31-Jul-23Update to Chapter 3 – All ManualsAll Providers Participating in the Virginia Medicaid and FAMIS Programs
27-Jul-23Update to Nursing Facility Manual, Chapter 5All Providers Participating in the Virginia Medicaid and FAMIS Programs
26-Jul-23Patient Pay Underpayments Have Been StoppedAll Providers and Managed Care Organizations Participating with the Medicaid/FAMIS Programs
24-Jul-23Psychiatric Residential Treatment Facilities (PRTFs), Addiction and Recovery Treatment Services (ARTS) Providers, All Providers Participating in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations, and the Behavioral Health Services AdminPsychiatric Residential Treatment Facility (PRTFs), Addiction and Recovery Treatment Services (ARTS) Residential Services Rate Changes Effective July 1, 2023
14-Jul-23Outpatient Rehabilitation Rates Effective July 1, 2023All Providers of Outpatient Rehabilitation Services Participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
14-Jul-23Nursing Facility and Specialized Care Rate Updates Effective July 1, 2023Nursing Facility, Specialized Care, and Hospice Service Providers; Commonwealth Coordinated Care (CCC) Plus Managed Care Organizations (MCO)
14-Jul-23Inpatient and Outpatient Hospital Rates Effective July 1, 2023All Hospitals and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
14-Jul-23Home Health Rates Effective July 1, 2023All Providers of Home Health Services participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
13-Jul-23New Case Management Service for Persons with Traumatic Brain InjuryAll Service Providers, Contracted Managed Care Organizations and Contracted Service Administrators
6-Jul-23Virginia Medicaid Preferred Drug List / Common Core Formulary Changes, 90 Day Supply List Changes, FDA Approval of Over-the-Counter Naloxone, and Drug Utilization Review Board Approved Drug Service AuthorizationsAll prescribing Providers, Pharmacists, and Managed Care Organizations Participating in the Virginia Medical Assistance Program
6-Jul-23Update to Chart of Provider FlexibilitiesAll Providers Participating in the Virginia Medicaid and FAMIS Programs
5-Jul-23Medicaid Home Health Care Services (HHCS) Provider Manual update to include Electronic Visit Verification (EVV)All Home Health Providers, Services Facilitation Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Program
1-Jul-23Post-Admission Long-Term Services and Supports (LTSS) Screenings by Skilled Nursing Facilities Effective July 1, 2023All Medicaid LTSS Screening Entities (Community Based Teams); other State Agencies involved in the Screening Process (DARS); Nursing Facilities, PACE sites; Acute Care Hospitals, and Medicaid Health Plans providing Care Coordination for LTSS
29-Jun-23Processing and Payment of Emergency Room Claims Effective April 27, 2023All Hospitals and Physicians Participating in the Virginia Medical Assistance Program and Managed Care Organizations (MCOs)
23-Jun-23Upcoming Changes to Service Authorization Criteria for Weight-Loss DrugsAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
16-Jun-23Notice of Kepro Rebranding to Acentra HealthAll Providers and MCOs Participating in the Virginia Medicaid and FAMIS Programs
14-Jun-23Updates to Chapter IV, VI, and Appendix H of the Mental Health Services ManualAll Providers of Behavioral Health Services, Commonwealth Coordinated Care (CCC) Plus Managed Care Plans and Medallion 4 Managed Care Plans
12-Jun-23Updates to Residential Treatment Services Manual Chapter 6All Providers Participating in the Virginia Medicaid and FAMIS Programs
7-Jun-23Kepro’s Atrezzo Upgrading to Atrezzo Next GenerationAll Providers and MCOs Participating in the Virginia Medicaid and FAMIS Programs
5-Jun-23Update to LTSS Services Manual Chapter 5All Providers Participating in the Virginia Medicaid and FAMIS Programs
1-Jun-23Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project UpdateAll Home Health Providers, Services Facilitation Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Program
18-May-23BHSA Changes Due to Magellan Contract Ending – Electronic Funds Transfer Update Required for Providers Currently Enrolled with the Magellan of Virginia Behavioral Health Services Administrator (BHSA)All Behavioral Health Services Administrator (BHSA) Providers
17-May-23Update to Psychiatric Services Manual Chapter 2All Providers Participating in the Virginia Medicaid and FAMIS Programs
10-May-23Updates to Baby Care Manual Chapter 6All Providers Participating in the Virginia Medicaid and FAMIS Programs
9-May-23Updates to Chapter 2 of LTSS Screening ManualAll Providers Participating in the Virginia Medicaid and FAMIS Programs
8-May-23New Emergency Medicaid Services SupplementAll Providers Participating in the Virginia Medicaid and FAMIS Programs
25-Apr-23Reimbursement for COVID services under Emergency Medicaid after the end of the federal Public Health EmergencyAll Providers, Contractors, and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
20-Apr-23Telehealth Updates to Outpatient Psychiatric and Addiction Recovery and Treatment Services (ARTS) ServicesAll Providers of Behavioral Health Services, Commonwealth Coordinated Care (CCC) Plus Managed Care Plans and Medallion 4 Managed Care Plans
20-Apr-23No requirement for exclusive telemedicine providers to maintain a physical presence in Virginia/in-state addressAll Providers, Contractors, and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
17-Apr-23Updated coverage of Pfizer-BioNTech bivalent COVID-19 vaccine booster doses for select children 6 months through 4 years of ageAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
10-Apr-23Notice of Award for RFP 2022-06 Service Authorization and Specialty Services ContractAll Providers, Contractors, and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
10-Apr-23Update to Chart of Provider FlexibilitiesAll Providers Participating in the Virginia Medicaid and FAMIS Programs
7-Apr-23Resource Disregard for Institutional and Community Based Waiver Services - REVISEDAll Providers Participating in the Virginia Medicaid and FAMIS Programs
4-Apr-23Temporary PACE Flexibilities Ending May 11, 2023Programs of All-Inclusive Care for the Elderly (PACE) Providers
30-Mar-23Hospital Providers to Submit Requests for Non-Resident Alien Emergency Inpatient Admissions to Kepro for Service Authorization - effective March 13, 2023All Inpatient Hospital Providers
30-Mar-23Return to Normal Enrollment – Frequently Asked QuestionsAll Providers Participating in the Virginia Medicaid and FAMIS Programs
28-Mar-23Information on the Eligibility Renewal Process - REVISEDAll Providers Participating in the Virginia Medicaid and FAMIS Programs
28-Mar-23Fraud Alert Related to Eligibility RedeterminationsAll Providers Participating in the Virginia Medicaid and FAMIS Programs
7-Mar-23Updated coverage of Moderna and Pfizer-BioNTech bivalent COVID-19 booster doses, coverage of Novavax COVID-19 booster doses and CLIA requirements for select COVID-19 testingAll Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
1-Mar-23Revised Outpatient Hospital Rates – Effective July 1, 2022All Hospitals and Managed Care Organizations (MCO) Participating in the Virginia Medical Assistance Program
22-Feb-23Return to Normal Enrollment Town Halls/Listening SessionsAll Providers Participating in the Virginia Medicaid and FAMIS Programs
16-Feb-23Public Health Emergency Ends on May 11, 2023All Providers Participating in the Virginia Medicaid and FAMIS Programs
14-Feb-23Updates to Comprehensive Crisis and Transition Services (Appendix G) of the Mental Health Services ManualAll Providers of Behavioral Health Services, Commonwealth Coordinated Care (CCC) Plus Managed Care Plans and Medallion 4 Managed Care Plans
7-Feb-23Update to Durable Medical Equipment and Supplies RatesAll 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
6-Feb-23Resource Disregard for Institutional and Community Based Waiver ServicesAll Providers Participating in the Virginia Medicaid and FAMIS Programs
26-Jan-23Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project UpdateAll Home Health Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
12-Jan-23Updates to the Mental Health Services ManualAll Providers of Behavioral Health Services, Commonwealth Coordinated Care (CCC) Plus Managed Care Plans and Medallion 4 Managed Care Plans
9-Jan-23End of Continuous Coverage and Update on Provider FlexibilitiesAll Providers Participating in the Virginia Medicaid and FAMIS Programs