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Medallion 4.0


Overview

Medallion 4.0 is Virginia’s Medicaid program for infants, children, pregnant women and adults in low-income families with children. It provides acute and primary healthcare services, prescription drug coverage and behavioral health services.


 




Community Mental Health Rehabilitation Services

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 Webpage.


Medallion 4.0 Focus

  • Evolving from the Medallion 3.0 foundation
  • Serving healthy, connected Medicaid & FAMIS members & their communities
  • Engaging Health Systems & Stakeholders
  • Providing holistic & integrated care
  • Adding new services & populations
  • Flexible delivery systems & payment models
  • Growing stronger through improved quality, data & reporting

 

Timelines

Important Medallion 4.0 Managed Care Timeline Dates
Milestones Proposed Dates*
Post Request for Proposals (RFP) July 17, 2017
Announce Awards Late Fall 2017
Medallion 4.0 Managed Care Regional Effective Dates
Regions Proposed Effective Dates*
Tidewater Region Effective Date August 1, 2018
Central Region Effective Date September 1, 2018
Northern/Winchester Region Effective Date October 1, 2018
Charlottesville/Western Region Effective Date November 1, 2018
Roanoke/Alleghany Region Effective Date December 1, 2018
Southwest Region Effective Date December 1, 2018