More Medicaid Information

DMAS sent this email recently (12/22/17) to share with behavior analysts.  For more information about the CCC Plus changeover from Magellan to MCOs, please login to the member area for our Medicaid page.

Checking Medicaid Eligibility

It is important for providers to verify a member’s Medicaid eligibility at each point of service. Verification of a member’s participation in CCC Plus can be done through the DMAS MediCall audio response system (1-800-884-9730 or 1-800-772-9996) or the DMAS web-based internet option, available on the Virginia Medicaid Web Portal, at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal.   As members are assigned to a CCC Plus health plan, the status of the enrollment is reflected in the member eligibility information data available on the 21st of every month for the first of the following month.  For example, Medicaid enrolled providers can see assignment information beginning on Oct 21 for individuals who have an Nov 1st start date in the Southwest Region.

Both options are available at no cost to the provider. The web-based, automated response system (ARS) limits the provider’s verification submission to 10 members at a time.  CCC Plus enrollment can also be verified through the member’s health plan.

CMHRS Transition and Eligibility Verification- IMPORTANT!

Community Mental Health Rehabilitation Services (CMHRS) providers also have access to the Magellan of Virginia provider web portal where member eligibility can be verified for all members.  This provider portal is especially useful during the CCC Plus CMHRS transition as the Virginia Medicaid Web Portal is enhanced to again allow access for all behavioral health providers to verify eligibility.  DMAS will provide updates to providers as the portal functionality is again turned on for CMHRS providers in early 2018.

Transition of Community Mental Health Rehabilitation Services (CMHRS) to CCC Plus

The CMHRS transition to CCC Plus will occur January 1, 2018.  On this date, Magellan of Virginia, DMAS’s Behavioral Health Services Administrator (BHSA), will no longer administer CMHRS for CCC Plus-enrolled members.  Instead, CMHRS will transition into the CCC Plus MCO contract, utilizing DMAS’ current CMHRS coverage criteria and program requirements.   CMHRS coverage for Medallion 3.0 members will continue to be administered through Magellan of Virginia until the implementation of Medallion 4.0 in 2018. Magellan of Virginia will continue to manage the CMHRS services for individuals who are enrolled in the DMAS fee-for-service program (including, but not limited to, the Governor’s Access Plan, individuals who are excluded from managed care, and individuals who are awaiting managed care enrollment). The list of services that will transition into CCC Plus on January 1, 2018 includes:

Please note that Treatment Foster Care Case Management and Therapeutic Group Home services (formerly known as Level A and Level B) will remain carved-out of CCC Plus at this time.

Additionally, all CCC Plus MCOs are required to pay the CMHRS providers using established DMAS reimbursement rates as the minimum payment level. There will be no changes made to current program regulations, medical necessity criteria, procedure codes, and unit values for these services at this time.  Some Service Authorization processes were standardized across the CCC Plus MCOs as a result of work groups held with DMAS, the Virginia Association of Community Services Boards (VACSB), Behavioral Health Associations and MCOs.  In addition, DMAS hosted workgroup meetings with the CCC Plus MCOs and Behavioral Health provider association representatives about credentialing requirements, CMHRS program requirements, claims processing, and care coordination.

The CMHRS standardized forms, MCO Authorization Process,  Provider Reference Guide, CMHRS provider training recorded webinars and more information are available on the CCC Plus website under CMHRS Transition.

Please note that for CMHRS providers who are enrolled with the Behavioral Health Service Administrator (Magellan of Virginia) and who no longer have an enrollment with DMAS, CCC Plus enrollment information is visible in the Magellan portal.  Please refer to the section above on eligibility verification processing.