Department of Medical Assistance Services

Medicaid Memos to Provider

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Medicaid Memos to Provider For 2006

Medicaid Memos to Provider For 2005 - 1999

Date	Subject	Providers
September 3, 2008	Phase II of Tamper-Resistant Prescription Pad (TRPP) Requirements – Effective October 1, 2008	All Pharmacies, Medical Providers, Dental Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
August 15, 2008	Screening for Technology Assisted Waiver for Community Based Assessments	All Technology Assisted Waiver Providers and Local Community Based Pre-Admission Screening Teams which include local Hospitals, local Health Departments, and local Departments of Social Services.
August 13, 2008	Physician Rate Changes Update – Effective July 1, 2008	All Physicians and other providers billing CPT codes participating in the Virginia Medical Assistance Program, FAMIS, and Managed Care Organizations providing services to Virginia Medicaid and FAMIS recipients.
July 3, 2008	Reimbursement for New Ambulatory Surgery Center Procedure Codes	Ambulatory Surgery Centers participating in the Virginia Medical Assistance Program, FAMIS, and Managed Care Organizations providing services to Virginia Medicaid and FAMIS recipients
July 1, 2008	Expansion of Medallion II & FAMIS Programs in the Charlottesville Area: Albemarle, Augusta, Buckingham, Charlottesville, Fluvanna, Greene, Louisa, Nelson, Orange, Staunton, and Waynesboro – November 1, 2008	All Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
June 20, 2008	Rate Corrections for Outpatient Substance Abuse Services – Effective July 1, 2008	All Managed Care Organizations (MCOs), Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Residential Inpatient Facilities, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
June 18, 2008	Rate Increases for Congregate Residential and Agency-Directed Individual Supported Employment Services – Effective July 1, 2008	Intellectual Disabilities/Mental Retardation (ID/MR); Individual and Family Developmental Disabilities Support (DD); and Day Support (DS) Waiver Providers.
June 11, 2008	Introduction of Money Follows the Person (MFP) – Effective Date July 1, 2008 New Services Added to Existing Waivers – Effective Date July 1, 2008	All Home and Community Based Waiver Providers, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program, Area Agencies on Aging (AAA), Community Service Boards (CSBs), Local Departments of Social Services, and Community Independent Living Centers
May 30, 2008	Changes to the Prior Authorization Process for Intensive In-Home Services – Effective July 1, 2008	All Intensive In Home Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
May 30, 2008	New Prior Authorization Process for Level A (Children’s Group Home) and Level B ( Therapeutic Group Home) Psychiatric Residential Treatment Facility Providers – Effective July 1, 2008	All Psychiatric Residential Treatment Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons
May 29, 2008	Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program, Effective July 1, 2008; Changes to the Enhanced Prospective Drug Utilization Review Program (Dose Optimization); and, Implementation of the Specialty Maximum Allowable Cost Program	All Pharmacy and Medical Providers Participating in the Virginia Medical Assistance Programs.
May 28, 2008	New Remittance Advice (RA) Format – June 21, 2008 & NPI Reminder – May 23, 2008	Department of Medical Assistance Services (DMAS) Participating Providers
May 28, 2008	Physician Rate Changes – Effective July 1, 2008	All Physicians participating in the Virginia Medical Assistance Program, FAMIS, and Managed Care Organizations providing services to Virginia Medicaid and FAMIS recipients.
May 23, 2008	Medicaid Coverage of Substance Abuse Services Screening Codes	All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Clinical Psychologists, Mental Health/Mental Retardation Agencies, Licensed Clinical Social Workers, Psychiatric Clinical Nurse Specialists, Nurse Practitioners, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
May 1, 2008	Changes to the Prior Authorization Process performed by KePRO for Outpatient Substance Abuse Services	All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Clinical Psychologists, Psychiatric Nurse Practitioners, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
April 9, 2008	Summary of New Federal Targeted Case Management Final Regulations – Effective March 3, 2008	All Providers of Case Management Services and MCOs Participating in the Virginia Medical Assistance Programs
April 2, 2008	Prior Authorization – Children’s Mental Health Program will Transition to KePRO for Fee-for-Service Enrollees – Effective May 1, 2008	All Waiver Providers, Psychiatric Residential Treatment Facilities, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program
April 2, 2008	New National Drug Code (NDC) Billing Requirement for Pharmacy Claims Submissions (UB04/837I) – Effective July 1, 2008	All Acute/General and Rehabilitation Hospital Providers and MCOs Participating in the Virginia Medical Assistance Programs
April 1, 2008	Using Your National Provider Identification/Atypical Provider Identification (NPI/API) through iEXCHANGE for Requests Submitted to KePRO – Effective 5/23/2008	All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers; All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers; All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services; All Home and Community Based Care Waiver Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
March 5, 2008	National Provider Identifier (NPI) Compliance Begins May 23, 2008	All Providers
March 1, 2008	Billing for Emergency and Non-Emergency Transportation Services – Effective 04/01/2008	All Ground, Air and Neonatal Ambulance, All Managed Care Organizations (MCOs) and Providers participating in the Virginia Medical Assistance Program
February 29, 2008	Update on Tamper-Resistant Prescription Pad Requirements Effective April 1, 2008 and National Provider Identifier (NPI) Compliance for Pharmacy Claims Processing Effective May 23, 2008	All Pharmacy, Medical Providers, Dental Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
February 20, 2008	Physician Assistant Supervision Requirements	All Medical Doctors, Nurse Practitioners, Nurse Midwives, Hospitals, Outpatient Health Facilities, Nursing Homes, Mental Health Providers, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
February 4, 2008	Introduction of New Fax Form to Request Prior Authorization for Acute Inpatient Psychiatric Care Services and Freestanding Inpatient Psychiatric Care Services -- Concurrent Review Only	All Inpatient Acute and Inpatient Freestanding Psychiatric Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Program
December 26, 2007	Plan First - The Medicaid Fee-For-Service Family Planning Waiver Program – Eligible Population, Enrollment, Covered Services, Service Limits and Billing Requirements as well as Upcoming Training Dates - Effective January 1, 2008	All Medical Doctors, Nurse Practitioners, Professional Midwives, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Pharmacies, Outpatient Clinics and Managed Care Organizations Participating in the Virginia Medical Assistance Program
December 20, 2007	Prior Authorization – Outpatient Substance Abuse Services that will Transition to KePRO for Fee-for-Service Enrollees – Effective January 1, 2008	All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Clinical Psychologists, Psychiatric Nurse Practitioners, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
December 11, 2007	Children’s Mental Health Program – Effective December 1, 2007	All Potential Providers of the Children’s Mental Health Program, Psychiatric Residential Treatment Facilities, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program
December 4, 2007	Changes to Enhanced Prospective Drug Utilization Review Programs and Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program Effective January 1, 2008	All Pharmacy and Medical Providers Participating in the Virginia Medical Assistance Programs
October 19, 2007	Outpatient Substance Abuse Services that require Prior Authorization for Fee-for-Service Enrollees	All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Psychologists, Clinical Psychologists, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Residential Inpatient Facilities, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
October 19, 2007	Updates and Clarification of the Prior Authorization Process for Outpatient Services	All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
October 11, 2007	Medicaid Enrollment and Coverage of Certified Professional Midwives	All Virginia Licensed Certified Professional Midwives, Medical Doctors, Nurse Practitioners, Nurse Midwives, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Outpatient Clinics, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Program
October 9, 2007	Changes to the Prior Authorization and Billing Process for Psychiatric Residential Treatment and Treatment Foster Care - Effective October 1, 2007	All Psychiatric Residential Treatment Providers, Treatment Foster Care Case Management Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons
October 9, 2007	Prior Authorization Updates - Waivers – Effective Immediately	All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
October 3, 2007	Delayed Implementation of Tamper Resistant Prescription Pad Requirements Now Effective April 1, 2008	All Pharmacy, Medical Providers, Dental Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
October 2, 2007	Discontinuation of Legacy Automated Response System (ARS) Access	All Providers Participating in the Virginia Medical Assistance Program
September 12, 2007	Virginia Medicaid Healthy ReturnsSM Disease Management Program Expanded to Include Chronic Obstructive Pulmonary Disease (COPD) Effective May 1, 2007	All Providers (with the exception of Dentists) and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Programs
September 5, 2007	Implementation of Tamper-Resistant Prescription Pad Requirements – Effective October 1, 2007	All Pharmacy, Medical Providers, Dental Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
August 30, 2007	Update to Second Edition of the Durable Medical Equipment and Supplies Provider Manual	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.
August 27, 2007	Provider Education for the Hospital Utilization Review Audit Process	All Inpatient Acute and Inpatient Psychiatric Service Providers.
August 23, 2007	Early Periodic Screening Diagnosis and Treatment (EPSDT) Screening and Developmental Assessments	Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Providers and DMAS-Enrolled Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
August 8, 2007	Integration of Acute and Long Term Care Services - Phase I	All Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations (Excluding Dental Providers).
August 1, 2007	Enrollment of Additional Specialties of Licensed Nurse Practitioners – Effective August 1, 2007	Physicians, Nurse Practitioners, Clinical Nurse Specialists, Nurse Midwives, Hospitals, State Mental Hospitals, Private Mental Hospitals, Residential Treatment/Treatment Foster Care Facilities, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, School Health Clinics,Outpatient Clinics, and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Programs
July 31, 2007	Provider Satisfaction Survey for Prior Authorization Services	All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers; All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers; All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services; All Home and Community Based Care Waiver Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
July 13, 2007	New Rates and Processing of Emergency Room Physician Claims – Effective July 1, 2007	Emergency Room Physicians Participating in the Virginia Medical Assistance Program and Managed Care Organizations providing services to Virginia Medicaid Recipients
July 5, 2007	Expansion of Managed Care Services in Lynchburg – Effective October 1, 2007	All Providers (with the exception of Dentists) and Managed Care Organizations (MCOs) participating in the Virginia Medical Assistance Programs
June 26, 2007	Increase in the Personal Needs Allowance for Institutionalized Individuals Residing in Nursing Facilities and in Intermediate Care Facilities for the Mentally Retarded (ICF-MR) – Effective July 1, 2007	All State Mental Hospitals, Long Stay Hospitals, Skilled Nursing Home Mental Health Facilities, Medical Surgery Facilities serving the Mentally Retarded, Skilled Nursing Homes, Skilled Nursing Facilities, Long Stay Inpatient Hospitals, Mental Health Medical Surgery Facilities, and Intermediate Care Facilities participating in the Virginia Medicaid Program.
June 12, 2007	Medicaid Coverage of Substance Abuse Services – Effective July 1, 2007	All Managed Care Organizations (MCOs), Physicians, Licensed Professional Counselors, Licensed Psychologists, Clinical Psychologists, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS), Licensed Clinical Social Workers, Psychiatric Residential Inpatient Facilities, Psychiatric Clinical Nurse Specialists, Licensed Marriage and Family Therapists, and Licensed Substance Abuse Treatment Practitioners.
June 7, 2007	BabyCare Rate Changes – Effective July 1, 2007	All Providers of Maternal Infant Care Coordination (MICC) services participating in the Virginia Medical Assistance Programs, including Physicians, Nurse Practitioners, Nurse Midwives, Health Department Clinics, Federally Qualified Health Centers, Rural Health Clinics, Department of Social Service, Case Management Providers, Prenatal Nutritionists, Private Home Health Agencies and Community Service Boards, and High Risk Maternity and Infant Program Managers of the Medicaid Managed Care Organizations (MCOs).
June 5, 2007	Physician Rate Increases – Effective July 1, 2007	All Physicians participating in the Virginia Medical Assistance Program, FAMIS, and Managed Care Organizations providing services to Virginia Medicaid and FAMIS recipients.
June 5, 2007	Rate Increase for Personal Care and Related Services – Effective July 1, 2007	All Personal Care and Related Services Providers.
June 5, 2007	Northern Virginia Rate Differential for MR, DD, and Day Support Waiver Services – Effective July 1, 2007	Mental Retardation (MR), Individual & Family Developmental Disabilities Support (DD) and Day Support Waiver ProvidersPrograms.
May 31, 2007	New National Drug Code (NDC) Billing Requirement for Drug-Related HCPCS J-Codes – Effective July 1, 2007	All Prescribing Physician Providers Participating in the Virginia Medical Assistance Programs.
May 31, 2007	Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program, Enhanced Prospective Drug Utilization Review Programs, National Provider Identifier (NPI) Dual Use Extension, and Pharmacy Web-Based Prior Authorization Process	All Pharmacy and Prescribing Medical Providers Participating in the Virginia Medical Assistance Programs.
May 8, 2007	National Provider Identifier (NPI) Update: DMAS Dual Use Period Extended Beyond May 23, 2007 & Paper Claim Form Deadline (June 1, 2007)	All Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations.
April 23, 2007	Changes to the Prior Authorization Request Form for Intensive In-Home Services	All Intensive In-Home Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
April 23, 2007	Changes to the Prior Authorization Process for Psychiatric Residential Treatment	All Psychiatric Residential Treatment Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons.
April 19, 2007	New Questionnaires Available to Facilitate Waiver Services Requests for Prior Authorization	All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
April 19, 2007	Northern Virginia Rate Differential for MR, DD, and DS Waivers – Effective July 1, 2007	Mental Retardation (MR) Waiver, Individual & Family Developmental Disabilities Support (DD)Waiver, and Day Support (DS) Waiver providers.
March 19, 2007	NPI Update: DMAS Requirements for National Taxonomy Codes for Home Health, Private Duty, and Atypical Service Providers	Virginia Medicaid Participating Home Health, Private Duty Nursing, Personal Care, Respite, Adult Day Health, Assisted Living, MH-MR Services, Case Management Waiver, Family Caregiver Training, and Treatment Foster Care Providers.
March 12, 2007	Changes to the Prior Authorization Process for Treatment Foster Care Case Management – Effective March 1, 2007	All Treatment Foster Care Case Management Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs, and all CPMT Chairpersons.
February 21, 2007	General Billing Instructions for the New CMS-1450 (UB-04) - Effective April 1, 2007	All Providers Billing on the CMS-1450 (UB-04) Form.
February 14, 2007	Updates and Clarification of the Prior Authorization Process for Inpatient Services	All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs Assistance Programs.
February 14, 2007	Updates and Clarification of the Prior Authorization Process for Outpatient Services	All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs.
February 12, 2007	National Provider Identifier (NPI) Update: DMAS Requirements for National Taxonomy Codes	Virginia Medicaid Participating Acute Care, Rehabilitation, and Psychiatric Hospitals (Acute and Free-Standing), Residential Treatment Facilities,and Emergency Land and Air Ambulance Provider.
February 9, 2007	Atypical Provider Identifier (API) Update: DMAS Dual Use Period – March 26 - May 22, 2007 – March 26 - May 22, 2007	Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations.
February 9, 2007	National Provider Identifier (NPI) Update: DMAS Dual Use Period – March 26 - May 22, 2007	Virginia Medicaid Participating Healthcare Providers and Managed Care Organizations.
January 31, 2007	Baby Care Mileage Rate Increase – Effective February 1, 2007	All Providers of Maternal Infant Care Coordination (MICC) services participating in the Virginia Medical Assistance Programs, including Health Department Clinics, Federally Qualified Health Centers, Rural Health Clinics, Department of Social Service, Case Management Providers, Private Home Health Agencies and Community Service Boards.
January 31, 2007	Changes to Treatment Foster Care Case Management Reimbursement – Effective March 1, 2007	Providers of Treatment Foster Care Case Management
January 19, 2007	New Web Site for the Automated Response System (ARS) and National Provider Identifier (NPI) Compliance for the ARS – Effective February 19, 2007	All Providers Participating in the Virginia Medical Assistance Program
January 10, 2007	Updates and Clarification of the Prior Authorization Process for Community Based Care Services	All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
January 10, 2007	Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services	All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
January 10, 2007	Updates and Clarification of the Prior Authorization Process for Outpatient Services	All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
January 10, 2007	Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management, Residential Treatment Services, and Intensive In-Home Services	All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services and Managed Care Organizations Participating in the Virginia Medical Assistance Programs