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2025 Memos and Bulletins

Issue DateTitleTo:
1-Oct-25Change from RUG to PDPM Grouper for Nursing Facility Claim Payments Effective October 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
30-Sep-25Telehealth Services UpdateAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
26-Sep-25Drug Utilization Review (DUR) Meeting Decisions Effective October 1, 2025All Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
9-Sep-25Updates to the DD Waiver Provider Manual Chapter 6Developmental Disabilities Waiver Providers
9-Sep-25Update to Practitioner Manual, Chapter 7 (Appendix D Service Authorization)All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
9-Sep-25Update to Hospital Manual, Chapter 7 (Service Authorization)All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
9-Sep-25Continuous Glucose Monitoring (CGM) Coverage UpdateAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
27-Aug-25Consumer-Directed (CD) Services Facilitation (SF) Requirements and RemindersConsumer-Directed Services Facilitators and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
22-Aug-25Delayed Billing for Certain Long-Acting Injectables in any Hospital Emergency Department or Hospital Inpatient Setting Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
13-Aug-25Service Authorization Update for Applied Behavior Analysis (ABA) Effective October 15, 2025Mental Health Services Providers, Cardinal Care Managed Care Organizations (MCOs), Acentra Health
12-Aug-25Update to 1915(c) Home and Community Based Services (HCBS) Waivers Amendments - Implementation of Combined Budget for Assistive Technology and Electronic Home Based Supports Effective September 1, 2025Providers of Developmental Disabilities Waiver Services, Community Services Boards
1-Aug-25Revised Update to Pending 1915(c) Home and Community-Based Services (HCBS) Waivers Amendments—Approvals and Procedure Changes to Legally Responsible Individuals Effective July 1, 2025Services Facilitators (SF), Personal Care Agencies, Assistive Technology Providers, Electronic Home-Based Services providers, Managed Care Organizations (MCO), Community Services Boards
31-July-25Inpatient and Outpatient Hospital Rates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
28-July-25Requirement of Application Fee for Provider Class Type 60-Pharmacy and/or Provider Class Type 61-Pharmacy-Long Term Care Effective August 1, 2025All Pharmacies Participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
22-July-25Maternal Health Bills and Budget Items Effective July 1, 2025All Providers participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs))
17-July-25Updates to the Mental Health Services Manual and Temporary Detention Orders SupplementAll Providers of Behavioral Health Services, Acentra Health, and Cardinal Care Managed Care Organizations
14-July-25Updates to Chapter II of the Plan First ManualAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid Program
9-July-25Delayed Billing for Certain Long-Acting Injectables in any Hospital Emergency Department or Hospital Inpatient Setting Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
7-July-25Updates to the Addiction and Recovery Treatment Services (ARTS) ManualUpdates to the Addiction and Recovery Treatment Services (ARTS) ManualAll Providers of Behavioral Health Services, Acentra, Cardinal Care Managed Care Organizations
1-July-25Addiction and Recovery Treatment Services (ARTS) Rates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-July-25Physician Administered Drug Procedure Code Rate Additions Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-July-25Nursing Facility and Specialized Care Rates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-July-25Outpatient Rehabilitation Rates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-July-25Resource Based Relative Value Scale (RBRVS) Rates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-July-25Clinical Laboratory Services Procedure Code Rate Additions Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
1-July-25Waiver Rate Updates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
23-June-25Updated Provider Enrollment Requirements- Effective July 1, 2025All Providers participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
23-June-25Psychiatric Residential Treatment Facility (PRTFs), Addiction and Recovery Treatment Services (ARTS) Residential Services Rates - Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
23-June-25Personal Care Rate Updates Effective July 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
23-June-25Home Health Rates Effective July 1, 2025All Providers of Home Health Services participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)
16-June-25Drug Utilization Review (DUR) Meeting, Pharmacy and Therapeutics (P&T) Meeting, and Prescription Monitoring Program (PMP) Compliance Effective July 1, 2025All Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
10-June-25Update to Pending 1915(c) Home and Community-Based Services (HCBS) Waivers Amendments—Approvals and Procedure Changes to Legally Responsible Individuals Effective July 1, 2025Services Facilitators (SF), Personal Care Agencies, Assistive Technology Providers, Electronic Home-Based Services providers, Managed Care Organizations (MCO), Community Services Boards
6-June-25Retirement of Appendices D and E from the Pharmacy Provider ManualAll Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
29-May-25July 1, 2025 Implementation of New Cardinal Care Managed Care ContractAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
28-May-25Updates to The Intensive Clinic Support Appendix (Appendix F) 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
23-May-25Updates to the Durable Medical Equipment and Supplies Manual Chapter IVAll 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
19-May-25End of Flexibilities Under Section 1902(e)(14)(A)All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
15-May-25DMAS-80 Form RevisionAll Nursing Facility Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
8-May-25Update to Nursing Facility Manual Supplement: Protection of Residents’ FundsAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
29-Apr-25Updates to Chapter 7 (Appendix D) of the Hospital ManualAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
11-Apr-25Updates to Chapter V of the Psychiatric Services ManualAll Providers of Behavioral Health Services, Acentra, Cardinal Care Managed Care Organizations
4-Apr-25Updates to BabyCare Provider Manual Chapters 2 and 4All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
13-Mar-25Updates to All Provider Manuals, Chapter 3 (Member Eligibility)All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
11-Mar-25Annual Service Plan Contractor for Fee-For Service Individuals on the CCC Plus Waiver with PDN Effective 3/11/2025All Fee For Service Commonwealth Coordinated Care (CCC) Plus Waiver Private Duty Nursing (PDN) Providers
26-Feb-25Virginia Medicaid Preferred Drug List / Common Core Formulary and New Drug Utilization Board Approved Drug Service Authorizations Effective April 1, 2025All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
13-Feb-25Updates to Rehabilitation Manual, Appendix D (Service Authorization)All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
11-Feb-25Per Diem Inpatient Billing for Psychiatric and Rehabilitation Services – Effective February 11, 2025All Acute Care General Hospital, Inpatient Psychiatric, Inpatient Rehabilitation Providers, and MCOs
3-Feb-25Updates to Brain Injury Services Targeted Case Management SupplementCase Management Services Providers and Contracted Managed Care Organizations
21-Jan-25Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled MedicationsAll Behavioral Health Providers
16-Jan-25Updates to the Intensive Community Based Support Appendix (Appendix E) 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
16-Jan-25Updates to the Service Authorization Appendix (Appendix C) of the Psychiatric Services ManualAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
2-Jan-25Plan First Program Changes Chapter IVAll Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
1-Jan-25Virginia Medicaid Preferred Drug List / Common Core Formulary and New Drug Utilization Board Approved Drug Service Authorizations Effective January 1, 2025All Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Program
1-Jan-25Consumer-Directed Work Shift Submission Requirements, Effective January 1, 2025Services Facilitators, Managed Care Organizations, Community Services Boards