If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. ), Individual and Family Developmental Disabilities Support Waiver (12VAC30-120-700 et seq. Providers must provide a valid taxonomy code for their services provided. Development of the recovery, resiliency, and wellness plan shall include collaboration with the individual. The direct supervisor must be available by telephone for consult within 24 hours of service delivery if needed. If the individual has not been discharged from the nursing facility during the 60-day period of services, mental health skill-building services shall be terminated and no further service authorizations shall be available to the individual unless a provider can demonstrate and document that mental health skill-building services are necessary. There are service authorization process changes that may impact your services to Kepro. DMAS provides a number of sources of data including for Medicaid Expansion and Enrollment Data. March 17, 2022. "Resiliency" means the same as defined in 12VAC30-130-5160. Department of Medical Assistance Services Chapter 50. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590 600 East Broad Street Richmond Virginia. and answers about provider claims, enrollment and training. 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. Payments shall not be permitted to providers that fail to enter into an enrollment agreement with DMAS or its contractor. Directories, manuals, supplements and lab lists 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. 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. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. Their income must be within the limits. A future notice will be sent to you requiring your updated licensing information to be submitted for continued enrollment. 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. The ISP contains, but is not limited to, the individual's treatment or training needs, the individual's goals and measurable objectives to meet the identified needs, services to be provided with the recommended frequency to accomplish the measurable goals and objectives, the estimated timetable for achieving the goals and objectives, and an individualized discharge plan that describes transition to other appropriate services. Virginia Medicaid Provider Enrollment Services, P.O. Member and Provider Services. (3) Outpatient mental health clinic services licensed by the Department of Behavioral Health and Developmental Services. 32.1-325 of the Code of Virginia; 42 USC 1396 et seq. Effective May 1, 2019, DMAS has a new Policy change for children in the Commonwealth Coordinated Care Plus waiver. (DMAS) planned and began building MES in 2016, to replace Virginias existing all-in-one-box solution. Amount, Duration, and Scope of Medical and Remedial Care Services Part III. 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. 13.4 Definitions An LMHP-resident shall be in continuous compliance with the regulatory requirements of the applicable counseling profession for supervised practice and shall not perform the functions of the LMHP-R or be considered a "resident" until the supervision for specific clinical duties at a specific site has been preapproved in writing by the Virginia Board of Counseling. Find out more about how this website uses cookies to enhance your browsing experience. For Comments & Questions about Managed Care. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. 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: 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. News and Updates. Several types of training are now online: To get started, please visit the MES Provider Training page. Amount, Duration, and Scope of Services 12VAC30-50-226. For Members; For Providers; COVID-19 Response; Contact; Data and Reports; Medallion 4.0 Non-Expansion Members . b. Reimbursement shall be subject to retraction for any billed service that is determined to not to be in compliance with DMAS requirements. e. Individuals 21 years of age or older qualifying for mental health peer support services shall meet the following requirements: (1) Require recovery-oriented assistance and support services for the acquisition of skills needed to engage in and maintain recovery; for the development of self-advocacy skills to achieve a decreasing dependency on formalized treatment systems; and to increase responsibilities, wellness potential, and shared accountability for the individual's own recovery. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. Navigate. j. The Provider Helpline is available Monday to Friday between 8am and 5pm. Find out more about how this website uses cookies to enhance your browsing experience. f. These services may only be rendered by an LMHP, LMHP-R, LMHP-RP, LMHP-S, a QMHP-A, a QMHP-C, a QMHP-E, or a QPPMH. of Title 37.2 of the Code of Virginia. These services are intended to be delivered in a person-centered manner. 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. 600 East Broad Street Richmond Virginia. "LMHP-supervisee in social work," "LMHP-supervisee," or "LMHP-S" means the same as "supervisee" is defined in 18VAC140-20-10 for licensed clinical social workers. a. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1 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. Crisis intervention shall provide immediate mental health care, available 24 hours a day, seven days per week, to assist individuals who are experiencing acute psychiatric dysfunction requiring immediate clinical attention. In April 2022, the Virginia Department of Medical Assistance Services (DMAS) launched a new portal to manage provider enrollment -the Provider Services Solution (PRSS). Kepro will process requests with the old forms through May 31, 2019. 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. 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. Medical record documentation shall fully substantiate the need for services when personal care or attendant care services are being provided. Department of Medical Assistance Services, Chapter 50. The next open enrollment dates are: Southwest region December 19, 2022 February 28, 2023. Provider Toolkit. The next open enrollment dates are: Southwest region December 19, 2022 February 28, 2023. 600 East Broad Street Richmond Virginia. The PRS shall act as an advocate for the individual, encouraging the individual to take a proactive role in developing and updating goals and objectives in the individualized recovery planning. The following words and terms when used in this section shall have the following meanings unless the context clearly indicates otherwise: "Activities of daily living" or "ADLs" means personal care tasks such as bathing, dressing, toileting, transferring, and eating or feeding. b. Navigate. Navigate. 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 You may check the status of your enrollment application once submitted by using the login information that will be supplied to you during the initial enrollment registration process. 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. Policy and Provider Manual ; Credentialing . (DMAS) planned and began building MES in 2016, to replace Virginias existing all-in-one-box solution. Individuals have the right to appeal an action that denies, reduces, or terminates Medicaid or FAMIS coverage. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590 New Provider Enrollment. M4.0-CMHRS@dmas.virginia.gov. Sentara Health Plans, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. The individuals who are receiving these services shall be included in all service planning activities. 2. Please visit the MES website to review Frequently Asked Questions and answers about provider claims, enrollment and training. Navigate. ARTS and Behavioral Health HCBS Rate Increases Navigate. g. The provider shall clearly document details of the services provided during the entire amount of time billed. 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. Providers shall be reimbursed only for training activities defined in the ISP and only where services meet the service definition, eligibility, and service provision criteria and this section. 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. On April 1, 2017, Virginias Medicaid Program launched an enhanced substance use disorder treatment benefit Addiction and Recovery Treatment Services (ARTS). 600 East Broad Street Richmond Virginia. Medicaid providers will utilize the PRSS portal, located on Requirements for the comprehensive needs assessment are set out in 12VAC30-60-143. Payments shall not be permitted to providers that fail to enter into an enrollment agreement with DMAS or its contractor. c. Individuals shall be discharged from this service when they are no longer in an acute psychiatric state and other less intensive services may achieve psychiatric stabilization. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590 Two units of service shall be defined as at least four but less than seven hours in a given day. 23219 For Medicaid Enrollment Web: www.coverva.org Tel: 1-833-5CALLVA TDD: 1-888-221-1590. "DBHDS" means the Department of Behavioral Health and Developmental Services consistent with Chapter 3 ( 37.2-300 et seq.) Family member statements shall not suffice to meet this requirement. "LMHP-resident" or "LMHP-R" means the same as "resident" as defined in (i) 18VAC115-20-10 for licensed professional counselors; (ii) 18VAC115-50-10 for licensed marriage and family therapists; or (iii) 18VAC115-60-10 for licensed substance abuse treatment practitioners. (2) The individual shall have at least one of the following as a primary mental health diagnosis: (d) Any other serious mental health disorder that a physician has documented specific to the identified individual within the past year and that includes all of the following: (i) is a serious mental illness or serious emotional disturbance; (ii) results in severe and recurrent disability; (iii) produces functional limitations in the individual's major life activities that are documented in the individual's medical record; and (iv) requires individualized training for the individual in order to achieve or maintain independent living in the community. Providers must provide a valid taxonomy code for their services provided. DMAS. "LMHP-resident in psychology" or "LMHP-RP" means the same as an individual in a residency, as that term is defined in 18VAC125-20-10, program for clinical psychologists. Educational opportunities and resources. Supervision of the PRS shall also meet the following requirements: the direct supervisor shall perform direct supervision of the PRS as needed based on the level of urgency and intensity of service being provided. For more information and service authorization forms, please visit the CMHRS Transition Webpage. DMAS Data. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation. The preferred submission method is through direct data entry(Atrezzo Connect)for a quicker response. 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. k. Only the licensed and enrolled provider referenced in subdivision 7 j of this subsection shall be eligible to bill mental health peer support services. Roanoke/Allegheny region December 19, 2022 February 28, 2023 Appeals for providers, individuals or entities that have a contract with DMAS to provide services. January 30, 2015; Volume 32, Issue 22, eff. Services shall be provided following a face-to-face comprehensive needs assessment by an LMHP, LMHP-supervisee, LMHP-resident, or LMHP-RP or a certified prescreener assessment. Instead, CMHRS and Behavioral Therapy will transition into the Medallion 4.0 MCO contract, utilizing DMAS current CMHRS coverage criteria and program requirements. Table of Contents Title 12. 600 East Broad Street Richmond Virginia. This criterion shall be met in order to be initially admitted to services and not for subsequent authorizations of service. February 1, 2004; Volume 27, Issue 10, eff. Provider Appeals . 600 East Broad Street Richmond Virginia. Authorization and Registration DMAS. Click below to learn more about how MES directly and efficiently supports the business needs of DMAS and our Providers. Announcements. All services which do not require service authorization require registration. Specific peer support service activities shall emphasize the acquisition, development, and enhancement of recovery, resiliency, and wellness. 600 East Broad StreetRichmondVirginia. Copyright Commonwealth of Virginia, document.write(new Date().getFullYear()). For children who do not have a new or existing waiver enrollment, these services must be submitted under the EPSDT service type 0091, utilizing the EPSDT rules and forms.

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