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Virginia Department of Medical Assistance Services

Medicaid Memos to Provider

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Date

Subject

Providers
April 21, 2008 Plan First - The Medicaid Fee-For-Service Family Planning Waiver Program – New Provider Manual

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
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