Virginia Medicaid
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Overview

Virginia Medicaid provides an array of behavioral health and addiction and recovery treatment services through Managed Care Organizations (MCOs) (through CCC Plus and Medallion 4.0), and through the Behavioral Health Services Administrator, which are contracted by DMAS. You can find notices related to regulatory and manual updates, including dates for public comment periods, are posted on the Virginia Regulatory Townhall Website at: http://www.townhall.virginia.gov


Update on HCBS Rate Increases

The Virginia Department of Medical Assistance Services (DMAS) values the important work of home and community-based care providers, including providers of services for physical and behavioral health needs. We understand the challenges they have faced over the past year as they continue to ensure our members have access to critical services during the COVID-19 pandemic. The budget passed during the August 2021 special session includes a 12.5% increase for community based service providers starting July 1, 2021. On October 6, 2021, DMAS issued a Medicaid memo with additional information about this initiative. 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. A Provider FAQ on the rate increase is also available.

Background and General Information

 

Magellan of Virginia serves as the Behavioral Health Services Administrator or "BHSA" and is responsible for the management and administration of the fee for service (FFS) behavioral health benefit programs under contract with DMAS. Magellan of Virginia is authorized to create, manage, enroll, and train a FFS provider network; render service authorizations; adjudicate and process claims; gather and maintain utilization data; reimburse providers; perform quality assessment and improvement activities; conduct member outreach and education; resolve member and provider issues; and perform utilization management of services and provide care coordination for members receiving FFS Medicaid-covered behavioral health services.  For more information about Magellan of Virginia, please consult Magellan’s National Provider Handbook , the Magellan Virginia Provider Handbook, contact Magellan of Virginia at: 800-424-4536 or VAProviderQuestions@MagellanHealth.com, or visit: http://www.magellanofvirginia.com  

Community Mental Health Rehabilitative Services

Community Mental Health Rehabilitative Services (CMHRS) are intended to provide clinical treatment to those individuals with significant mental illness or children with, or at risk of developing, serious emotional disturbances. CMHRS include benefits available to individuals who meet the service specific medical necessity criteria based on diagnoses made by a Licensed Mental Health Professional (LMHP), LMHP- Resident in Counseling, LMHP-Supervisee in Social Work or LMHP-Resident in Psychology within the scope of their practice.  The clinical management of CMHRS services have transitioned to Managed Care Organizations (MCOs), providing coverage for over 90% of Medicaid enrollees through the Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) health plans (effective 8/1/18 for CCC Plus, 8/1/18 for Medallion 4). Residential Treatment Services and Treatment Foster Care Case Management are excluded from Medicaid MCOs and continue to be obtained through our Fee-for-Service vendor Magellan of Virginia. For further information and forms, please visit the CMHRS Transition Webpage.

The Community Mental Health Rehabilitation Services (CMHRS) and Behavioral Therapy transition to Medallion 4.0 will occur in accordance with the regional implementation of the program, beginning August 1, 2018. On each effective date, Magellan of Virginia, DMAS’s Behavioral Health Services Administrator (BHSA) will no longer administer CMHRS and Behavioral Therapy for Medallion 4.0 enrolled members. Instead, CMHRS and Behavioral Therapy will transition into the Medallion 4.0 MCO contract, 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. CMHRS providers will follow the CCC Plus authorization processes for Medallion 4.0. Providers will use the same CCC Plus authorization/registration forms found on the DMAS website. Questions regarding the CMHRS transition into Medallion 4.0 can be e-mailed to M4.0-CMHRS@dmas.virginia.gov. For more information and service authorization forms, please visit the CMHRS Transition Webpage.

Commonwealth Coordinated Care Plus

CCC Plus is a managed long-term services and supports (MLTSS) program. This mandatory Medicaid managed care program serves individuals with complex health care needs through an integrated delivery model that includes medical services, behavioral health services and long-term services and supports.

Effective January 1, 2018, CMHRS transitioned to CCC Plus for CCC Plus enrolled members. The BHSA no longer administers CMHRS for CCC Plus enrolled members. The CCC Plus MCOs are utilizing DMAS’ current CMHRS coverage criteria and program requirements. For more information about the CCC Plus MCO coverage, please visit the CMHRS Transition Webpage.

Addiction Recovery And Treatment Services

On April 1, 2017, Virginia’s Medicaid Program launched an enhanced substance use disorder treatment benefit – Addiction and Recovery Treatment Services (ARTS). For more information, please visit the ARTS Webpage.