"Register" or "registration" means notifying DMAS or its contractor that an individual will be receiving services that do not require service authorization. Discharge summaries from prior providers that clearly indicate (i) the type of treatment provided, (ii) the dates of the treatment previously provided, and (iii) the name of the treatment provider shall be sufficient to meet this requirement. You will get a letter with more information. Navigate. Provider Orientation. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Optima Health Insurance Company. Their income must be within the limits. The PRS shall perform mental health peer support services under the oversight of the LMHP, LMHP-R, LMHP-RP, or LMHP-S who shall provide the clinical oversight of the recovery, resiliency, and wellness plan. Navigate. This criterion shall be met in order to be initially admitted to services and not for subsequent authorizations of service. f. ICT services shall be reviewed by an LMHP, LMHP-R, LMHP-RP, or LMHP-S for all individuals who have received at least six months of ICT to determine the continued need for this service. Once the report is generated you'll then have the option to download it as a pdf, print or email the report. For Members; For Providers; COVID-19 Response; Contact; Data and Reports; Family member statements shall not suffice to meet this requirement. You can also fax your letter to 1-888-335-8476. The Kepro (service authorization) contract excludes: Kepro accepts service authorization requests via Atrezzo Connect (an interactive web-based application), telephone, paper, and fax submission. "Comprehensive needs assessment" means the same as defined in 12VAC30-50-130 and also includes individuals who are older than 21 years of age. One unit of service shall be defined as a minimum of two but less than four hours on a given day. (10) Individuals who have organic disorders, such as delirium, dementia, or other cognitive disorders not elsewhere classified, will be prohibited from receiving mental health skill-building services unless their physicians issue signed and dated statements indicating that the individuals can benefit from this service. "Qualified mental health professional-child" or "QMHP-C" means the same as defined in 54.1-3500 of the Code. This documentation shall be maintained in the individual's mental health skill-building services record, and the provider shall document and describe how the individual will be able to actively participate in and benefit from services without the assistance of medication. 32.1-325 of the Code of Virginia; 42 USC 1396 et seq. Screening Navigate. Provider Find out more about how this website uses cookies to enhance your browsing experience. Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. The DMAS Appeals Division is responsible for fairly and impartially providing due process to clients and healthcare providers in full compliance with Virginia law and Medicaid policy. c. An individual service plan shall be initiated at the time of admission and must be fully developed, as defined in this section, within 30 days of the initiation of services. Family member statements shall not suffice to meet this requirement. Enhanced Behavioral Health services seek to keep Virginians well and thriving in their communities, reduce the need to focus on crisis by investing in prevention and early intervention for mental health and substance use disorder (SUD) comorbidities, and support a comprehensive alignment of services across the systems that serve Medicaid members. DMAS. Navigate. Questions regarding the CMHRS transition into Medallion 4.0 can be e-mailed toM4.0-CMHRS@dmas.virginia.gov. Family member statements shall not suffice to meet this requirement. DMAS. Providers will use the same CCC Plus authorization/registration forms found on the DMAS website. Individuals must meet at least two of the following criteria at the time of admission to the service: (1) Experience difficulty in establishing and maintaining normal interpersonal relationships to such a degree that the individual is at risk of psychiatric hospitalization, homelessness, or isolation from social supports; (3) Exhibit such inappropriate behavior that immediate interventions documented by the mental health, social services, or judicial system are or have been necessary; or. 23219For Medicaid EnrollmentWeb: www.coverva.orgTel: 1-833-5CALLVATDD: 1-888-221-1590. DMAS. January 30, 2015; Volume 32, Issue 22, eff. March 17, 2022. These services shall provide goal-directed training in the following areas in order to be reimbursed by Medicaid or the DMAS contractor: (i) functional skills and appropriate behavior related to the individual's health and safety, instrumental activities of daily living, and use of community resources; (ii) assistance with medication management; and (iii) monitoring of health, nutrition, and physical condition with goals towards self-monitoring and self-regulation of all of these activities. Please review this memo to learn more about the specific services covered by the rate increase and the timeframe when the new rate will be effective. Medicaid Provider Manual Drafts ; Service Authorization ; Long Term Care DMAS. Open enrollment is November 1, 2022 December 31, 2022. On October 6, 2021, DMAS issued a Medicaid memo with additional information about this initiative. Navigate. Home | Virginia Managed Care Authorization is required for Medicaid reimbursement. Virginia Medicaid Provider Enrollment Services, P.O. Department of Medical Assistance Services, Certain waiver enrollment/service authorizations [pdf], DMAS - Department of Medical Assistance Services, Breast & Cervical Cancer Prevention and Treatment Act, Addiction and Recovery Treatment Services, Hospital Presumptive Eligibility Information, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Behavioral Health Service Utilization and Expenditures, Legislative and Congressional District Reports, Monthly Expenditure Reports of the Medicaid Program, Nursing Facility Value-Based Purchasing Program, CHIP State Plan and Waiver-Related Documents, | | s -w-po-ny | | | Deutsch | | Tagalog | Franais | | Igbo asusu | | | Espaol | | Ting Vit | Yorb. The CCC Plus MCOs are utilizing DMAS current CMHRS coverage criteria and program requirements. Using the Integrated Care Model, this benefit will impact over 750,000 Medicaid members, including children enrolled in Medallion 4.0 and Family Access to Medical Insurance Security (FAMIS) Plan. Using the Integrated Care Model, this benefit will impact over 750,000 Medicaid members, including children enrolled in Medallion 4.0 and Family Access to Medical Insurance Security (FAMIS) Plan. Roanoke/Allegheny region December 19, 2022 February 28, 2023 Staff travel time shall not be included in billable time for reimbursement. Navigate. The Provider Helpline is available Monday to Friday between 8am and 5pm. Their income must be within the limits. DMAS. A written comprehensive needs assessment that documents the individual's eligibility and the need for this service must be completed prior to the initiation of services. Two units are defined as at least four but less than seven hours in a given day. Home | MES - Virginia Using the Integrated Care Model, this benefit will impact over 750,000 Medicaid members, including children enrolled in Medallion 4.0 and Family Access to Medical Insurance Security (FAMIS) Plan. For Providers Amount, Duration, and Scope of Medical and Remedial Care Services, Part III. Provider FAQ. Direct supervisors shall maintain documentation of all supervisory sessions. Virginia Medicaid Provider Enrollment Services, P.O. (DMAS) planned and began building MES in 2016, to replace Virginias existing all-in-one-box solution. DMAS Virginia Premier has been inspiring healthy living in the communities we serve since 1995. Please visit the MES website to review Frequently Asked Questions and answers about provider claims, enrollment and training. Should old forms be submitted to Kepro on/after June 1, 2019 Kepro will reject the request for the new forms. For Providers On each effective date, Magellan of Virginia, DMASs Behavioral Health Services Administrator (BHSA) will no longer administer CMHRS and Behavioral Therapy for Medallion 4.0 enrolled members. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1 Home [virginia.hppcloud.com] Providers shall be required to ensure that if an individual is receiving additional therapeutic services that there will be coordination of services by either the LMHP, LMHP-R, LMHP-RP, LMHP-S, QMHP-A, QMHP-C, QMHP-E, or QPPMH to avoid duplication of services. DMAS Appeals For Members; For Providers; COVID-19 Response; Contact; ARTS and Behavioral Health HCBS Rate Increases Find out more about how this website uses cookies to enhance your browsing experience. The Provider Enrollment Guide is needed for some Provider courses, and will help with the new enrollment process. Effective January 1, 2018, CMHRS transitioned to CCC Plus for CCC Plus enrolled members. 1. Navigate. For managed care assistance, call 800-643-2273 or email ManagedCareHelp@dmas.virginia.gov. THERE ARE NO AUTOMATIC RENEWALS. Provider Manuals Library. "Affiliated" means any entity or property in which a provider or facility has a direct or indirect ownership interest of 5.0% or more, or any management, partnership, or control of an entity. The comprehensive needs assessment shall document the individual's behavior and describe how the individual meets criteria for this service. A Provider FAQ on the rate increase is also available. DMAS. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. For managed care assistance, call 800-643-2273 or email ManagedCareHelp@dmas.virginia.gov. Please contact the Provider Helpline at 1-800-552-8627 (in-state long distance) or (804) 786-6273 (local and out of state customers) for services that are currently authorized by DMAS Medical Support Unit; Certain waiver enrollment/service authorizations [pdf] Maintained by DMAS Office of Community Living Provider Appeals . The budget passed during the August 2021 special session includes a 12.5% increase for community based service providers starting July 1, 2021. These services may only be rendered by an LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, a QMHP-A, a QMHP-C, a QMHP-E, or a QPPMH. November 16, 2017; Volume 35, Issue 10, eff. DMAS CMHRS Webinars Aug And Sept 2018. There are service authorization process changes that may impact your services to Kepro. Two units of service shall be defined as at least four but less than seven hours in a given day. 600 East Broad Street Richmond Virginia. Medical record documentation shall fully substantiate the need for services when personal care or attendant care services are being provided. "DMAS" means the Department of Medical Assistance Services and its contractor consistent with Chapter 10 ( 32.1-323 et seq.) Box 26803, Richmond, VA 23261-6803. Roanoke/Allegheny region December 19, 2022 February 28, 2023 April 14, 2021; Volume 38, Issue 12, eff. Medallion 4.0 Non-Expansion Members . Helpful information for new and existing providers. 23219For Medicaid EnrollmentWeb: www.coverva.orgTel: 1-833-5CALLVATDD: 1-888-221-1590. Crisis stabilization services for nonhospitalized individuals shall provide direct mental health care to individuals experiencing an acute psychiatric crisis which may jeopardize their current community living situation. Providers will use the same CCC Plus authorization/registration forms found on the DMAS website. A. Definitions. Virginia The individuals who are receiving these services shall be included in all service planning activities. Medallion 4.0 CMHRS & Behavioral Therapy Provider Training Slide Deck July2018. Day treatment/partial hospitalization services shall be time limited interventions that are more intensive than outpatient services and are required to stabilize an individual's psychiatric condition. mental health Health Agency 30. The direct supervisor (i) shall have two consecutive years of documented practical experience rendering peer support services or family support services, have certification training as a PRS under a certifying body approved by DBHDS, and have documented completion of the DBHDS PRS supervisor training; (ii) shall be a qualified mental health professional (QMHP-A, QMHP-C, or QMHP-E) as defined in 12VAC35-105-20 with at least two consecutive years of documented experience as a QMHP, and who has documented completion of the DBHDS PRS supervisor training; or (iii) shall be an LMHP, LMHP-R, LMHP-RP, or LMHP-S who has documented completion of the DBHDS PRS supervisor training who is acting within his scope of practice under state law. c. These services may only be rendered by an LMHP, an LMHP-supervisee, LMHP-resident, LMHP-RP, or a certified prescreener. g. Discharge criteria from mental health peer support services is the same as set forth in 12VAC30-130-5180 E. h. Mental health peer support services shall be rendered on an individual basis or in a group. If the individual is transitioning into an independent living situation, MHSS shall only be authorized for up to six months prior to the date of transition. Providers must provide a valid taxonomy code for their services provided. 600 East Broad Street Richmond Virginia. On and after June 1, 2019 Kepro will require the updated forms to be submitted with requests for Personal/Attendant Care Services. Providers will use the same CCC Plus authorization/registration forms found on the DMAS website. DMAS Review of the recovery, resiliency, and wellness plan means the PRS evaluates and updates the individual's progress every 90 calendar days toward meeting the plan's goals and documents the outcome of this review in the individual's medical record. Department of Medical Assistance Services. Please review the following new Medicaid Memos to Providers available through the Virginia Medicaid Web Portal using the link below: https://vamedicaid.dmas.virginia.gov/provider/library. "DSM-5" means the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, copyright 2013, American Psychiatric Association. DMAS provides a number of sources of data including for Medicaid Expansion and Enrollment Data. February 21, 2019; Volume 35, Issue 24, eff. Please visit the MES website to review Frequently Asked Questions and answers about provider claims, enrollment and training. On each effective date, Magellan of Virginia, DMASs Behavioral Health Services Administrator (BHSA) will no longer administer CMHRS and Behavioral Therapy for Medallion 4.0 enrolled members. Appeals for providers, individuals or entities that have a contract with DMAS to provide services. DMAS provides a number of sources of data including for Medicaid Expansion and Enrollment Data. These services include assessment, education to teach the patient about the diagnosed mental illness and appropriate medications to avoid complication and relapse, and opportunities to learn and use independent living skills and to enhance social and interpersonal skills within a supportive and normalizing program structure and environment. The goals of crisis stabilization programs shall be to avert hospitalization or rehospitalization, provide normative environments with a high assurance of safety and security for crisis intervention, stabilize individuals in psychiatric crisis, and mobilize the resources of the community support system and family members and others for on-going maintenance and rehabilitation. DMAS. For more information about the CCC Plus MCO coverage, please visit the CMHRS Transition Webpage. Training courses are available for all Medicaid providers. There are no enrollment costs and no monthly premiums for adults between 19-64 years old who qualify. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590 b. Questions regarding the CMHRS transition into Medallion 4.0 can be e-mailed to M4.0-CMHRS@dmas.virginia.gov. Site developed by the Division of Legislative Automated Systems (DLAS). "Strength-based" means the same as defined in 12VAC30-130-5160. Individuals qualifying for this service must demonstrate a clinical necessity for the service arising from mental, behavioral, or emotional illness that results in significant functional impairments in major life activities. The comprehensive needs assessment shall document the individual's behavior and describe how the individual is at risk of psychiatric hospitalization or is transitioning from a psychiatric hospitalization to the community. Please submit only one request form. Services managed under a separate contract, including pharmacy, dental, transportation, Behavioral Health, Intellectual Disability & Day Support Waivers, and managed care organization (MCO) vendor services; U.S. Mail - Kepro 2810 North Parham Road, Suite 305 Richmond, VA 23294. The CCC Plus MCOs are utilizing DMAS current CMHRS coverage criteria and program requirements. Department of Medical Assistance Services, DMAS - Department of Medical Assistance Services, Breast & Cervical Cancer Prevention and Treatment Act, Addiction and Recovery Treatment Services, Hospital Presumptive Eligibility Information, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Behavioral Health Service Utilization and Expenditures, Legislative and Congressional District Reports, Monthly Expenditure Reports of the Medicaid Program, Nursing Facility Value-Based Purchasing Program, CHIP State Plan and Waiver-Related Documents, | | s -w-po-ny | | | Deutsch | | Tagalog | Franais | | Igbo asusu | | | Espaol | | Ting Vit | Yorb. Their income must be within the limits. of Title 32.1 of the Code of Virginia. DMAS CMHRS Webinars Aug And Sept 2018. As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. "Individual" means the patient, client, or recipient of services described in this section. 600 East Broad Street Richmond Virginia. Services are designed to promote empowerment, self-determination, understanding, and coping skills through mentoring and service coordination supports, as well as to assist individuals in achieving positive coping mechanisms for the stressors and barriers encountered when recovering from their illnesses or disorders. Individualized goals and strategies shall be focused on the individual's identified needs for self-advocacy and recovery. Specific peer support service activities shall emphasize the acquisition, development, and enhancement of recovery, resiliency, and wellness. If you are the designated primary account holder (PAH) for your organization and did not receive emails explaining how to register for the new provider portal, you must submit a Primary Account Holder Request Form to obtain access. In April 2022, the Virginia Department of Medical Assistance Services (DMAS) launched a new portal to manage provider enrollment -the Provider Services Solution (PRSS). e. Only direct face-to-face contacts and services to the individual shall be reimbursable. Several types of training are now online: To get started, please visit the MES Provider Training page.