Tomorrow, March 13, is the deadline for the annual DMAS nursing facility wage survey. Participation is mandatory for all non-hospital-based nursing facilities participating in Virginia...
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What’s happening: VHCA-VCAL is making a final push to ask the budget negotiators to include funding for the Medicaid inflation increase in the FY27 and...
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The deadline to respond to the annual DMAS nursing facility wage survey is March 13, 2026. Participation is mandatory for all non-hospital-based nursing facilities participating...
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Help us sustain hometown compassionate care across Virginia. Care that feels like home takes more than heart. It takes time, staffing, stability, and policies that...
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Reminder: Responses to the annual nursing facility wage survey conducted by DMAS are due March 13, 2026. Participation is mandatory for all non-hospital-based nursing facilities...
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Action needed: Review this memo from DMAS on completing the annual nursing facility wage survey. Responses are due March 13, 2026. Participation is mandatory for...
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What’s happening: As one of the final acts of his term as governor, Gov. Glenn Youngkin presented a proposed two-year spending plan for state fiscal...
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What to know: VHCA-VCAL has obtained information from Anthem to assist providers in resolving billing issues related to the transition to Medicaid Patient-Drive Payment Model...
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What’s happening: November marks the first billing cycle since DMAS made the transition from a RUGs-based payment system to the Patient Driven Payment Model (PDPM)...
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What’s happening: On October 1, 2025, Virginia Medicaid shifted from a RUGs-based system to the Patient Driven Payment Model (PDPM). This change affects how nursing...
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What’s new: This week DMAS published the SFY 2027 Nursing Facility Value-Based Purchasing (VBP) Methodology. The updated methodology reflects several changes to the program metrics...
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Last chance for input: DMAS has asked VHCA-VCAL to share a short survey so the agency can better understand how nursing facilities provide access to dental care...
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Take this quick survey: DMAS has asked VHCA-VCAL to share a short survey so the agency can better understand how nursing facilities provide access to dental care...
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What to know: July 1 marks the start of the state fiscal year and the effective date of most legislation enacted in the General Assembly...
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Take this quick survey: DMAS is conducting a survey so the agency can better understand how nursing facilities provide access to dental care for Medicaid...
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Feedback needed: DMAS is committed to ensuring that all Medicaid beneficiaries have access to high-quality, comprehensive health services. As part of that mission, the agency...
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On June 11, DMAS announced all Medicaid fee-for-service (FFS) rates effective for dates of service beginning July 1, 2025, including nursing facility (NF) and specialized...
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What’s happening: DMAS has announced that effective July 1, 2025, it is implementing a new Cardinal Care Managed Care (CCMC) Contract. This May 29 Medicaid...
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What’s happening: As part of the final steps to formalize the state budget, the Clerk of the House of Delegates communicated to Gov. Glenn Youngkin...
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What’s happening: Congressional committees are developing legislation based on the federal budget resolution passed in April. Now is a critical time to ensure Medicaid is...
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What’s happening: Rep. Jen Kiggans (R-VA-02) and Rep. Rob Wittman (R-VA-01) publicly announced their opposition to the House Republican budget bill if it includes any...
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What’s happening: DMAS has competed its analysis of the first three metrics for this year’s first round of Medicaid nursing facility value-based payments (VBP). While...
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What’s happening: In a set of over 200 budget amendments released this week, Gov. Glenn Youngkin eliminated the $21.65 million for two years (total =...
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What’s happening: Sentara Health Plans has announced its PCH Portal is being retired and will not be accessible after April 15, 2025. Providers may continue...
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Reminder: Responses to the annual nursing facility wage survey conducted by DMAS are due March 14, 2025. Participation is mandatory for all non-hospital based nursing...
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Action needed: The annual nursing facility wage survey conducted by DMAS is now live. Responses are due March 14, 2025. Participation is mandatory for all...
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Send a message to your legislators: VHCA-VCAL is asking legislators to support funding in the Senate budget to increase Medicaid direct care rates. Budget conferees...
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Reach out to your members of the General Assembly to ask them to support budget amendments to increase funding for nurses and nurse aides so...
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What’s happening: DMAS has instructed its contracted managed care organizations (MCOs) to start pre-payment verification of information related to the payment transactions for the Year...
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What’s new: DMAS released a Medicaid Bulletin on October 3, 2024 outlining an enrollment change related to full benefit dual eligible Medicaid enrollees who participate...
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What’s happening: DMAS has officially posted the nursing facility Medicaid rates for each provider effective July 1, 2024. In the aggregate, the new operating rates...
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What’s happening: VHCA-VCAL was informed today that the payment process for the Medicaid Value-Based Payment (VBP) Year 2 Round 2 payments has been delayed relative...
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In follow up to last week’s news that DMAS published the Medicaid Bulletin with implementation guidance for the changes to the LTSS screening process to remove all...
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What’s new: On June 3, DMAS published the Medicaid Bulletin with implementation guidance on the VHCA-VCAL legislation modifying the LTSS screening process to remove all...
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What’s happening: The General Assembly will meet on April 17 to act on Gov. Glenn Youngkin’s budget amendment that would cut in half the Medicaid...
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What’s new: CMS has taken steps to expand financial relief opportunities for providers impacted by the cybersecurity incident affecting UnitedHealth Group Inc.’s technology subsidiary Change Healthcare. Providers...
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What’s happening: DMAS is in the final phase of a full reprocurement of the merged Cardinal Care managed care program. The agency has announced a...
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All Medicaid providers, including managed care organization (MCO) network providers, are required to revalidate their provider enrollment in the DMAS provider services solutions (PRSS) at...
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What’s happening: The cybersecurity incident affecting Change Healthcare which began on February 21 is having a broad impact on claims submissions and month-end billing for...
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The deadline to respond to the DMAS wage survey is tomorrow, February 16, 2024. Participation in the survey is mandatory for all free-standing nursing facilities participating...
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Action needed: Responses for the annual DMAS nursing facility wage survey are due February 16, 2024. Participation is mandatory for all non-hospital based nursing facilities...
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What’s happening: DMAS is finalizing the annual wage survey that will be the primary driver of the inflation calculation for rates effective on July 1,...
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What’s happening: As part of our pre-General Assembly session advocacy campaign, we are building awareness of the need for continued investments in the Medicaid program...
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What’s happening: A few weeks ago, VHCA-VCAL became aware of some issues with readiness to process Optional State Assessment (OSA)-based claims for both software vendors...
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VHCA-VCAL highlighted a series of significant concerns with the CMS proposed rule on staffing requirements for nursing facilities. In comments to the agency, VHCA-VCAL noted...
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What’s new: DMAS has posted the Year 3 (2025) methodology document for the Medicaid Nursing Facility Value Based Purchasing (VBP) Program. This document is relevant...
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What’s happening: CMS recently approved DMAS's application to combine its managed care waivers and operate a single managed care program through Cardinal Care Managed Care,...
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The General Assembly met Wednesday for a one-day session to finalize changes to the current state fiscal year budget. The approved budget sustained the $25...
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What’s new: DMAS has posted a bulletin explaining its implementation of the legislation HB 1681 and SB 1457). The bulletin describes the steps a nursing...
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Take this short survey to provide DMAS feedback on the first year of the Medicaid Value-Based Purchasing (VBP) Program. DMAS will accept responses until August...
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What’s happening: VHCA-VCAL is working to identify whether any members have outstanding VBP Year One payments remaining. If you have any expected amounts still unpaid,...
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Feedback wanted: DMAS is seeking feedback from Value-Based Purchasing (VBP) Program stakeholders, including nursing facility staff, on the first year of the program via a...
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A July 26 Medicaid Bulletin explains that DMAS has issued a broadcast notice to local departments of social services that staff should immediately stop calculating...
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What’s new: VHCA-VCAL previously reported that the Medicaid rates DMAS posted for the state fiscal year 2024, which began on July 1, included an error...
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What’s happening: Members alerted VHCA-VCAL with concerns about the calculation of patient pay amounts as part of the Medicaid redetermination process underway after the end...
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As Virginia works to redetermine eligibility for Medicaid recipients over the next several months for the first time since the beginning of the COVID emergency,...
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For your radar: DMAS intends to publish fiscal year 2024 Medicaid rates no later than July 1, 2023. DMAS made the announcement at a June...
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What’s happening: DMAS has informed VHCA-VCAL that the payment process for the second round of the Medicaid Value-Based Purchasing (VBP) program payments has begun. How...
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What’s coming: Effective July 1, 2023, Optima Health Plan will assume agreements with Virginia Premier providers. As of the merger effective date, Optima Health will...
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What’s new: DMAS has posted performance data for three metrics (days without eight RN hours, pressure ulcers, and urinary tract infections) used in the Medicaid...
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What’s new: DMAS posted two memos with details about the Medicaid redetermination process. The first memo, Information on the Eligibility Renewal Process - REVISED, includes...
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Good news: Following VHCA-VCAL’s discussions with the agency, DMAS will restart the payment process for the Medicaid Value Based Purchasing (VBP) Program for three of...
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AHCA/NCAL has prepared an array of resources on ahcancalED to help members manage significant numbers of Medicaid redeterminations with the upcoming end of the Public...
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What’s happening: We have identified a substantial error in the DMAS/Mercer calculation of the total nurse staffing metric results/payments under the new Value-Based Purchasing (VBP)...
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What’s happening: DMAS received notice from CMS that the consolidation of the two managed care contracts into one Cardinal Care Managed Care contract is still...
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On March 13 from 12:00 – 1:00 pm, DMAS will hold a nursing facility-specific session to discuss the start of the Medicaid eligibility re-determination process,...
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Effective April 1, 2023, Virginia Medicaid managedcare organizations (MCOs) will be prohibited from paying network providers until the provider is enrolled with the DMAS through the...
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Send your questions about Medicaid eligibility unwinding to Steve Ford by February 24. VHCA-VCAL will forward member questions to DMAS to help the agency prepare...
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Mark your calendar: On March 13 from 12:00 - 1:00 pm, DMAS will hold a nursing facility-specific session to discuss the start of the Medicaid...
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Virginia Medicaid will resume renewing enrollees’ eligibility beginning in March 2023. Get the information you need to help seniors enrolled in Medicaid renew their coverage...
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The deadline to respond to the DMAS wage survey is tomorrow, February 17. Participation in the survey is mandatory for all free-standing nursing facilities participating...
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What’s happening: The General Assembly’s budget negotiators are determining final funding amounts for the Value-Based Purchasing (VBP) Program and proposed Medicaid rate reforms proposed by...
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February 17 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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Good news: The budgets issued earlier this week by the House of Delegates and Senate budget-writing committees fund VHCA-VCAL’s priorities related to: Medicaid inflation, the...
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What’s happening: Beginning April 1, DMAS will return to its normal Medicaid enrollment processes, including redeterminations. Beginning in March, DMAS and DSS will begin reviewing...
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Coming up: On Sunday, February 5, the House and Senate budget-writing committees will release their proposals to amend the budget for the state fiscal years...
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DMAS issued a new fact sheet for providers and stakeholders about Cardinal Care. Cardinal Care is the new brand for the unified managed care program...
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DMAS has announced the lineup for its monthly LTSS Screening Connections Webinar Series designed to facilitate better communication around the state on LTSS Screening laws,...
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What’s happening: VHCA-VCAL submitted comments to DMAS in response to the agency’s request for comments on its intent to procure plan participants for the new...
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What’s new: Cheryl Roberts has been appointed director of the Department of Medical Assistance Services (DMAS) after serving as interim director since May. Roberts served...
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What’s new: DMAS released the first version of the SFY 2024 Nursing Facility Value-Based Purchasing (VBP) Program Methodology covering Year 2 of the program. While...
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Thursday, September 8, 2022 is the last day of the Long Term Services and Supports (LTSS) Screening catch-up period. Remember, if a nursing facility admits...
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Time is running out: The Long Term Services and Supports (LTSS) Screening catch-up period ends next week. If an individual is admitted to a nursing...
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The LTSS catch-up period set by DMAS ends September 8. Use this time to make sure all NF residents have the Long Term Services and...
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Time is running out in the catch-up period DMAS established to make sure all NF residents have the Long Term Services and Supports (LTSS) Screenings...
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Less than one month remains in the catch-up period to conduct LTSS Screenings for any individual residing in a nursing facility without one. Nursing facilities...
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DMAS posted the state fiscal year (SFY) 2023 Medicaid rates on July 1 (scroll down to “Reimbursement Rates”). The rates reflect the 14.74 percent inflation adjustment....
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With the approval of the 2023-2024 state biennial budget, DMAS has completed the final update to the Value-Based Payment (VBP) program methodology for 2023. The...
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You have two more opportunities to join us for a Lunch & Learn on the Medicaid LTSS Screening process for nursing facilities. Join us on...
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Sign up for one of the Lunch & Learn webinars VHCA-VCAL is hosting in July to review the LTSS Screening process for nursing facilities and...
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DMAS has posted a Medicaid Bulletin notifying providers that since the state budget was only signed by Gov. Glenn Youngkin on June 22, the 2023...
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Remember to use the catch-up period between now and September 8, 2022 to conduct LTSS Screenings for any individual residing in a nursing facility without...
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July 1 marks the formal start of the new Medicaid Value-Based Purchasing (VBP) Program. The program is replacing the value of the $15 per day...
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DMAS has asked VHCA-VCAL to assist in gathering some information on the use of complex rehabilitation technology (CRT) manual and power wheelchair bases and related...
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On June 10, 2022, DMAS posted two new Medicaid Bulletins related to the Medicaid Long Term Services and Supports (LTSS) Screening process. The first bulletin...
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In three weeks the per resident per day Medicaid add-ons will be replaced by the new Medicaid Nursing Facility Value-Based Purchasing (VBP) Program. The General...
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The General Assembly returned to Richmond on June 1 to vote on the final budget for the next two fiscal years (FY2023 and FY2024). The...
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Mark your calendars for Tuesday, April 12, 2022, from 3:30 to 4:30 pm for the next LTSS Screening Connection Webinar. This month’s webinar will feature...
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It’s not too late to register for the NF VBP Program Webinar Series: What You Need to Know Now, which begins on March 30. This...
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DMAS has posted Medicaid Bulletins on the agency’s transition from its Virginia Medicaid Management Information System (MMIS) to the new Medicaid Enterprise System (MES) and...
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Are you ready for the new Electronic Medicaid LTSS Screening (eMLS) System? Mark your calendars for an important LTSS Screening Connection Webinar on March 8,...
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Effective April 4, 2022, DMAS is transitioning the current Medicaid Management Information System (MMIS) to a more robust Medicaid Enterprise System (MES). Please make note...
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DMAS recently issued an update to the Nursing Facility Value-Based Purchasing (VBP) Methodology. The update is dated February 11, 2022. The methodology outlines the program...
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February 25 is the deadline for nursing facilities to complete and submit their Fair Rental Value (FRV) form and supporting documentation. The information is used...
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In reporting on the request from the Virginia and West Virginia governors to CMS for a waiver from the COVID-19 vaccine mandate, VHCA-VCAL’s Amy Hewett...
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VHCA-VCAL recently entered into a contract with the Department of Medical Assistance Services (DMAS) to administer the distribution of American Rescue Plan Act (ARPA) funds...
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DMAS training courses are now available for fee-for-service Medicaid providers to help you get ready for the launch of the Medicaid Enterprise System (MES) on...
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Contact your legislators today and ask them to implement Medicaid rate reforms to provide better cost coverage of the current costs of nursing-level care. We...
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February 18 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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February 18 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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DMAS has published Fair Rental Value (FRV) Reporting Form for Calendar Year (CY) 2021, which will be used to establish FRV rates for State Fiscal...
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DMAS issued a Medicaid Bulletin on January 13 on the temporary Virginia public health emergency due to COVID-19. The memo addresses the Medicaid flexibilities related...
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Responses for the annual DMAS nursing facility wage survey are due February 18, 2022. Participation in the Wage Survey is mandatory for all free-standing nursing...
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The first monthly LTSS Screening Connection Webinar of the year will be held January 11, 2022, from 3:30 to 4:30 pm. This month’s webinar will...
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DMAS has published the methodology for the nursing facility value-based purchasing program, which is designed to improve the quality of care furnished to Medicaid members....
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The 2021 General Assembly directed DMAS to develop a Medicaid Nursing Facility Value-Based Payment (VBP) program to replace the current $15 per day add-on when...
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DMAS posted the updated Screening Manual for Medicaid-Funded Long-Term Services and Supports (LTSS) on October 29 to the Provider Manuals Portal. The updated manual reflects...
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DMAS has issued a notice to nursing facilities asking them to make entries in the Level of Care Medicaid Portal for admissions, discharges and level...
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The recurring calls with CCC Plus managed care organizations (MCOs) to identify and troubleshoot claims processing issues will cease after this week. At this juncture,...
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DMAS sent a letter in error to some Medicaid members regarding “Premium Payment for Managed Care Organization and Estate Recovery.” The agency has mailed beneficiaries...
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DMAS has provided an updated list of DMAS-80 contacts and fax numbers. (Note this list is separate from the CCC Plus claims processing escalation contacts.)...
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DMAS will host a Nursing Facility Value Based Purchasing (VBP) Listening Session on September 22, 2021 from 3:30 – 5:00 pm. According to the agenda, DMAS...
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DMAS will host a Nursing Facility Value Based Purchasing (VBP) Listening Session on September 22, 2021 from 3:30 – 5:00 pm. According to the agenda,...
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Waivers related to admission screenings are affected by the June 30, 2021 expiration of Virginia’s public health emergency (PHE). The end of Virginia’s PHE means...
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New laws and updated Medicaid rates take effect on July 1, the start of Virginia’s state fiscal year (SFY). The budget passed by the General...
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As we previously reported, DMAS posted the Medicaid rates for the state fiscal year (SFY) that begins July 1, 2021. The agency has now posted...
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A Medicaid Memo dated June 11 outlines how DMAS will implement dental coverage for adults who are receiving full Medicaid benefits. The coverage includes comprehensive...
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Starting July 1, 2021, adults receiving full Medicaid benefits will be eligible for comprehensive dental care through DentaQuest. DMAS is encouraging Medicaid members to visit...
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DMAS has posted the Medicaid rates for the state fiscal year that begins July 1, 2021. Inflation from the 2021 rates to the 2022 rates...
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DMAS received updates on the CCC Plus managed care organization (MCO) directories contact lists by region. Please share this updated information with the appropriate staff...
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For several months now, DMAS, representatives of the CCC Plus managed care organizations (MCOs), VHCA-VCAL staff, and other industry stakeholders have been discussing the best...
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Medicaid providers are being asked to complete a DMAS survey to help the agency estimate the full fiscal impact of the scheduled minimum wage increases....
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DMAS has published a Medicaid Memo on COVID-19 flexibilities in effect through April 20, 2021. It includes information the specific flexibilities for nursing facilities that...
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DMAS is hosting its monthly LTSS Screening Connector call on March 9 at 3:30 pm. The calls are intended to facilitate better communication around the...
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In 2020 Virginia passed legislation implementing a phased increase to Virginia’s minimum wage. When the legislation was being discussed, DMAS, while acknowledging the impact across...
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February 26 is the deadline for nursing facilities to complete and submit their Fair Rental Value (FRV) form and supporting documentation. The information is used...
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February 21 is the deadline to respond to the DMAS wage survey. Participation in the survey is mandatory for all free-standing nursing facilities participating in...
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Key leaders of the Virginia’s budget-writing committees have begun negotiations on the state budget, including Medicaid funding for nursing facilities. We need your help in...
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DMAS has published the calendar year (CY) 2020 Fair Rental Value (FRV) reporting form and instructions. Nursing facilities must complete and submit the form and...
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Responses for the annual DMAS nursing facility wage survey are due February 21, 2021. Participation in the Wage Survey is mandatory for all free-standing nursing...
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Nursing facilities have until Monday, February 15 to submit this spreadsheet to DMAS to reconcile the $20 per day nursing facility supplemental payments for utilization between...
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DMAS is hosting its monthly LTSS Screening Connector call on February 9 at 3:30 pm. The calls are intended to facilitate better communication around the...
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February 15 is the deadline for nursing facilities to submit this spreadsheet to DMAS to reconcile the $20 per day nursing facility supplemental payments for utilization...
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A workgroup DMAS representatives, managed care organizations (MCO), and the nursing care sector have worked together to find a way to reconcile the special $20...
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Please provide updated census information through December 2020 to Steve Ford by January 8, 2021. This information will be used to support VHCA-VCAL’s advocacy efforts to obtain...
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On December 16 Gov. Ralph Northam presented his proposed amendments to the state’s biennial budget. In terms of direct impacts on nursing facilities, the proposed...
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DMAS has shared the presentation slides from the December 15 LTSS Screening webinar. The slides review the process skilled nursing facilities can use to establish...
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VHCA-VCAL is again completing census information to support our advocacy efforts to obtain continued COVID-19 assistance and permanent payment reforms to address historic Medicaid underfunding....
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Beginning January 1, 2021, skilled nursing facilities (SNFs) will be responsible for conducting LTSS Screenings for non-Medicaid members admitted to SNFs who have a change in...
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There is still time to register for the five-part Financial Conference that kicks off on Monday, December 7. Sessions will address post-acute financing and Medicaid,...
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The deadline for the Virginia Premier 2019 Claims Clean-Up project to reconcile any outstanding CCC Plus claims issues for calendar year (CY) 2019 is November...
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DMAS has announced that Jonathan Mattingly, whose experience includes work at other state Medicaid agencies and as a rate-setting consultant, has been hired to replace...
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DMAS has asked VHCA-VCAL to distribute the Fax Numbers & Escalation Contacts for the DMAS-80 Form (Updated October 2020) with updated contact information for the...
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The General Assembly concluded its special session earlier this week by considering Gov. Ralph Northam’s budget amendments. All of the long term care related funding...
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Make plans to attend the 2020 Financial Conference December 7, 8, and 10. The conference includes five interactive sessions over three days to help Virginia’s...
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For several weeks, DMAS has been engaged with three CCC Plus managed care organizations (MCOs), VHCA-VCAL, and LeadingAge Virginia to discuss how best to reconcile...
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With the extension of the COVID-19 public health emergency (PHE), DMAS applied for the extension of the state-based waivers allowing regulatory flexibility to providers. Per...
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As we informed you last week, General Assembly leaders agreed that supporting our seniors in long term care communities should be a priority during the...
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DMAS issued a Medicaid Bulletin on October 20 announcing the release of the updated on-line modular Medicaid Long Term Services and Supports (LTSS) Screening Training...
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In new Medicaid Memo, DMAS issued formal notification about changes to the item set fields required to be completed for the minimum data set (MDS)...
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On October 14, the House of Delegates and Senate of Virginia budget conferees released their compromise amendments to the current biennial budget. The compromise addresses...
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DMAS and the managed care organizations (MCOs), with VHCA-VCAL input, are working through the reconciliation process for the $20 per day Medicaid rate add-on invoicing...
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Virginia’s MDS/OASIS Coordinator has issued an instructional memo on the new requirement for nursing facilities to complete and submit specific MDS item set field associated...
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The House of Delegates and Senate of Virginia budget committees released their respective amendments to the current biennial budget, which included continued funding for the...
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Beginning October 1, 2020, DMAS will require providers to complete and submit specific MDS item set fields associated with the Patient Drive Payment Model (PDPM)...
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DMAS has notified VHCA-VCAL that beginning October 1, the agency will require the completion and submission of specific item set fields associated with all OBRA...
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In a recent Roanoke Times op-ed, Keith Hare, highlights the ongoing needs of Virginia’s nursing homes and also notes that for years Virginia’s nursing homes...
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In the context of the roster billing for the Medicaid $20 add-on, we previously alerted you that some Virginia Premier emails were not operational due...
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DMAS issued a memo on July 21 extended regulatory flexibilities during the COVID-19 public health emergency. The memo specifies that the additional $20 per day...
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On July 17, the US Department of Health and Human Services (HHS) extended the application deadline for the Medicaid tranche of the COVID-19 Provider...
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Virginia Premier has notified VHCA-VCAL that it is still experiencing problems with its group email inboxes. For the final roster billing for the $20 COVID...
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As previously reported, the $20 COVID add-on to the Medicaid rate has been incorporated into the system paid rates for dates of service beginning July...
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Virginia Premier is experiencing technical difficulties with emails as it transfers to the Sentara network. Group email boxes are not working properly. To avoid delays...
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As a reminder, our COVID-19 Resources webpage includes links to all of our member updates sent from April Payne, as well as the AHCA/NCAL updates....
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Skilled nursing facility (SNF) and assisted living (AL) residents were eligible for Economic Impact Payments (EIPs). EIPs are one-time payments of $1,200. AHCA/NCAL developed FAQs and guidance...
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DMAS has informed VHCA-VCAL that the agency will be changing the way the Medicaid $20 per day add-on is distributed. The now published 2021 operating...
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AHCA/NCAL has advocated for the last several weeks for US Department of Health and Human Services (HHS) to make provider relief payments to Medicaid...
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DMAS has issued a Medicaid Memo on New 1135 Waiver and Administrative Provider Flexibilities Related to COVID-19. It includes key information for nursing facilities (NFs)...
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Virginia Premier is available to work on 2019 claims clean up and has provided instructions for providers. We have also been notified that HMS has...
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For PACE participants residing in a nursing facility, the Medicaid $20 per day add-on for COVID-19 will follow the fee-for-service (FFS) hospice model. DMAS will...
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To receive the Medicaid $20 per day add-on, nursing facilities should submit their roster bills for April tomorrow, May 8, for payments expected by May...
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Gov. Ralph Northam’s Executive Order 58 suspended the Long Term Services and Supports (LTSS) screening requirements for all hospital discharges directly to a nursing facility...
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Earlier this week we communicated that DMAS finalized the guidance and templates and that the roster billing process for the per diem add-on had gone...
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The General Assembly met on Wednesday for its annual reconvened session to consider Gov. Ralph Northam’s action on bills and the budget passed during the...
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DMAS published a Medicaid Memo on provider flexibilities related to COVID-19 on April 22, 2020. The memo includes CCC Plus-specific items related to consent and...
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In the last week there have been two developments related to nursing facility Medicaid funding. First, on April 10, Gov. Ralph Northam approved a $20...
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DMAS has provided preliminary guidance regarding how stimulus checks will be treated for Medicaid purposes. DMAS expects this to be formalized in a set of...
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Providers may have recently received a letter stating that Optima Health will be retracting money paid for services rendered to Optima Health Community Care members....
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DMAS has advised that it has extended the Medicaid cost report filing deadlines to mirror the Medicare cost report filing extensions. We previously provided information...
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CMS indicates that providers should continue to code residents for the O0100M isolation item located in Chapter 3 of the MDS 3.0 RAI Manual v...
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DMAS has requested all health plans suspend timely filing requirements for nursing facility crossover claims back to the beginning of the CCC Plus program until...
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In a message to stakeholder associations, DMAS Director Karen Kimsey has asked associations to inform their members that any requests of DMAS be sent to...
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VHCA-VCAL has been in close communication with DMAS and DSS to answer member questions about Medicaid eligibility, renewals, how documents are to be signed, and...
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On March 25, the US Senate approved a stimulus package including provisions that would financially assist nursing facilities. The House of Representatives is expected to...
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Late last week, VHCA-VCAL submitted a request to Gov. Ralph Northam to increase Medicaid funding to address cost increases associated with preparation for and response...
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Twelve senior legislators have been appointed to work out the differences between the House of Delegates and Senate of Virginia budget proposals. Today VHCA-VCAL communicated...
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DMAS has re-surveyed the six CCC Plus managed care organizations (MCOs) for updated DMAS-80 submission contacts, including designated fax numbers and escalation staff should additional...
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Budget packages released on February 16 by the House of Delegates and the Senate of Virginia fully fund the Medicaid forecast and provide additional Medicaid...
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Virginia Premier has asked VHCA-VCAL remind members that it has set up a dedicated fax line to receive DMAS 80 forms and a dedicated phone...
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DMAS has shared additional clarification to nursing facilities to complete the Medicaid Managed Nursing Facility Managed Care Days Survey. The survey deadline is January 3,...
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Gov. Ralph Northam presented his final amendments to the current biennial budget and introduced his funding plan for the next two fiscal years (2021 and...
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DMAS notified nursing facilities on December 10 that the agency is extending the deadline for providers to complete the DMAS Medicaid Nursing Facility Managed Care...
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VHCA-VCAL was copied on an email from DMAS that requests providers fill out a “Survey Monkey” designating the number of Virginia Medicaid Nursing Facility Managed...
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On November 25, 2019, DMAS will publish an Exempt Action Final Regulation to eliminate the hospital’s three-day exception post-discharge for providing the Medicaid long-term services...
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Medicare’s change to PDPM effective October 1, 2019 has necessitated a change in how the Medicaid program calculates its liability, if any, for dual eligibles’...
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Two CCC Plus health plans, Virginia Premier and Magellan, have recently indicated systemic nursing facility claims issues that both, while different, seem to be related...
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VHCA-VCAL has heard from several members that audits of Anthem CCC Plus claims, undertaken by their contractor HMS, have been extremely problematic. Specifically, the scope...
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Since we shared the methodology for handling Part A claims under PDPM last week, DMAS has modified its guidance related to whether coinsurance days are...
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On October 7, CMS posted a revision to the PDPM DLL Package (V1.0003 FINAL). This revision replaces the previous version (V1.0002 FINAL). The new version...
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On October 1 the Patient-Driven Payment Model (PDPM) became the Medicare Part A fee-for-service payment system for skilled nursing facilities (SNFs). Check out resources and...
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September 13, 2019 is the deadline to submit spreadsheets with any outstanding Virginia Premier CCC claims issues and any outstanding Virginia Premier CCC Plus claims...
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In an effort to provide more specific issue resolution for nursing facility (NF) claims under CCC Plus, Virginia Premier has established a specific inbox for NF...
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DMAS has indicated it will be providing its decision on the approach to Part A crossover claims under the Medicare PDPM. Under PDPM, effective for...
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As we announced earlier this month, Virginia Premier is working to closeout any claims issues from the Dual Demonstration (CCC), which ran from August 2014...
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Virginia Premier, in consultation with VHCA-VCAL, has determined it would like to run a project to close out any remaining claims issues from the CCC...
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As we shared last week, DMAS is hosting a series of Q&A sessions on the new LTC Portal through August. DMAS has also shared two...
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[caption id="attachment_102075" align="alignright" width="266"] AHCA President and CEO Mark Parkison[/caption] AHCA President and CEO Mark Parkinson affirmed the industry’s commitment to quality care in a...
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DMAS has compiled a document listing the CCC Plus managed care organizations (MCO) fax numbers. Nursing facilities should use these numbers to submit a copy...
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As a reminder, DMAS has implemented procedural changes about how new admissions and level of care changes on and after July 1, 2019 are to...
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DMAS will be hosting weekly calls every Tuesday from 1:00 - 2:00 pm through August 27 to discuss questions related to the LTC Portal and...
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DMAS is hosting a second training session for nursing facilities on how to use the new Automated Enrollment and Disenrollment (AE&D) Portal (aka, “LTC Portal”)...
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An updated version of the guidance for implementation of the no UAI/no payment policy is available. The revision is dated July 1. The guidance was...
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Following extensive communication with DMAS over the last month, VHCA-VCAL has prepared additional guidance for members on how to prepare for the enforcement of the...
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In order to better align with CMS and DMAS billing standards, Virginia Premier has announced in a Provider Update it will be updating its claims...
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DMAS will soon enforce the “no UAI / no payment” policy for nursing facility residents admitted on and after July 1, 2019. This will be...
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Join April Payne on June 14 at 11:00 am for a webinar to answer your questions about the changes to the process for Long Term...
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Medicaid rates for state fiscal year 2020, which begins on July 1, 2019, have been posted to the Department of Medical Assistance Services (DMAS) website....
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According to the Department of Medical Assistance Services (DMAS), nursing facilities (NFs) will be able to bill the managed care organizations (MCOs) directly for the...
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As we have previously communicated, the Department of Medical Assistance Services (DMAS) will begin enforcing the “no UAI / no payment” policy for nursing facility...
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On May 28, The Centers for Medicare & Medicaid Services (CMS) released the final rule for Programs of All-Inclusive Care for the Elderly (PACE), the...
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Virginia Premier and Anthem, two of the managed care organizations which participated in the predecessor program to CCC Plus, known as Commonwealth Coordinated Care (CCC)...
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Effective July 1, 2019, the inflation increase for Medicaid rates for nursing facility services and specialized care for state fiscal year (SFY) 2020 will be...
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[caption id="attachment_105874" align="alignright" width="407"] Payment for Services Committee[/caption] VHCA-VCAL members and staff will again present their concerns about CCC Plus implementation to Department of Medical...
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Work on CCC Plus logic for Part A crossover claims processing has unveiled an issue that the Department of Medical Assistance Services (DMAS) now believes...
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The General Assembly adjourned on February 24, one day later than it was scheduled to, after reaching agreement on the budget. VHCA-VCAL is pleased to...
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A new AHCA/NCAL study shows that, on average, for-profit facilities took care of a significantly higher percentage of Medicaid beneficiaries as compared to not-for-profit (62.5...
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Earlier this week VHCA-VCAL Vice President of Quality Improvement April Payne shared advice to help members complete their PASRR/Level 1 screenings for residents who don’t...
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Nursing facilities have until February 22, 2019 to complete the annual Nursing Facility Wage Survey. Your responses to this survey are critical as the data...
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Are you making progress completing your Level 1 PASRR screening for all your residents? As a reminder, nursing facilities have until July 1 to ensure...
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The Department of Medical Assistance Services (DMAS) is hosting a Medicaid Expansion and Long Term Services and Supports (LTSS) webinar on January 23 from 11:00...
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AHCA/NCAL President and CEO Mark Parkinson wrote a memo to members describing the latest proposal to administer the Medicaid program via block grants to states....
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The Department of Medical Assistance Services (DMAS) is hosting a Medicaid Expansion and Long Term Services and Supports (LTSS) webinar on January 23, 2019 from...
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To assist with the CCC Plus Managed Care Organizations' (MCO) efforts to clean up the Medicare Part A bad debt, members should provide Steve Ford...
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McKnight’s Long Term Care News reported on comments by AHCA/NCAL President and CEO Mark Parkinson on low Medicaid reimbursement for nursing home care. He said,...
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With the end of the 2018 provider fiscal year and the deadline for cost reports, the Department of Medical Assistance Services (DMAS) has issued guidance...
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Each year the Department of Medical Assistance Services (DMAS) collects wage data from nursing centers. This data is used in the calculation of the annual...
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Nursing facilities should be taking steps between now and July 1 to ensure Level I screenings have been completed for all individuals. In a Medicaid...
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On December 18, Governor Ralph Northam presented his amendments to the current biennial budget to the General Assembly’s budget-writing committees. We are pleased to report...
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In a Medicaid Memo on the Preadmission Screening and Resident Review (PASRR) Process issued November 19, the Department of Medical Assistance Services (DMAS) has established...
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Now that CCC Plus is fully implemented statewide across all eligible populations, enrollees can choose their plan annually during open enrollment. The open enrollment period...
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With the latest round of conference calls on the CCC Plus program, it became evident that claims processing issues persist. VHCA-VCAL is disappointed at the...
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VHCA-VCAL signed on to a letter spearheaded by the Virginia Oral Health Coalition calling for a comprehensive dental benefit for all adults enrolled in Medicaid. ...
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DMAS will hold its final provider conference call on care coordination under CCC Plus on September 25 from 1:00 – 1:45 pm. Call-in number: 1-866-842-5779...
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On September 19, VHCA-VCAL provided comments to the Department of Medical Assistance Services (DMAS) recommending changes for the January 1, 2019 CCC Plus contract revision....
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Virginia Premier has distributed its Provider Resource Tool and asked VHCA-VCAL to share it with members. It includes various procedural items and contact information for...
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The Department of Medical Assistance Services (DMAS) will continue its new series of provider conference calls on care coordination under CCC Plus. The next call...
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We have heard from many of you that you are receiving contracts or addendums to your CCC Plus contracts pertaining to the Medallion 4.0 program...
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The CCC Plus Care Management Unit of the Department of Medical Assistance Services (DMAS) will be sponsoring twice monthly conference calls starting July 10. These...
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The Department of Medical Assistance Services (DMAS) has released the 2019 Medicaid nursing and specialized care rates, which take effect on July 1, 2018. The...
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In a special White House Rose Garden ceremony on June 6, President Donald Trump signed into law the VA Mission Act of 2018, which offers veterans...
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Gov. Ralph Northam has signed the fiscal year (FY) 2019-2020 budget, setting the stage for the inflationary adjustments for nursing center and specialized care services...
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VHCA-VCAL is aware that at least one CCC Plus managed care organization (MCO) has issued an addendum to its provider agreement and appears to have...
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After protracted debate that largely centered on whether the Commonwealth should extend Medicaid coverage to adults aged 19-64 who meet certain income limits under the...
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The Virginia Senate has opted to wait another week before acting on the state budget. It appeared earlier this week that the Senate might take...
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In response to feedback from VHCA members during the biweekly claims processing conference calls about paper claims being rejected on the front end and not...
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VHCA-VCAL submitted comments to the Department of Medical Assistance Services (DMAS) as the agency requested comments in advance of potential revisions to the CCC Plus...
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The Virginia Senate has opted to wait until May 14 to continue its work on the state budget. Senators have signaled that they would like...
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Skilled Nursing News spoke with providers and state officials about their roles in shaping Medicaid and Medicare managed care policies. Cleopatra Kitt, director of special...
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Gov. Ralph Northam has named Karen Kimsey as the new Chief Deputy of the Virginia Department of Medical Assistance Services (DMAS). Prior to her appointment,...
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Humana has provided instructions on how nursing centers can submit their final reconciliation/claim issues under the CCC (Dual Demo) program. Nursing centers should submit the...
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The General Assembly returned to Richmond this week to work on the state budget. It remains unclear how legislators will reach a conclusion on the...
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As the starting point for the April 11 special session on the state budget, Gov. Ralph Northam introduced the same budget proposed in December by...
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Gov. Ralph Northam issued a proclamation this week ordering the General Assembly back to Richmond on April 11 to work on the state budget. Legislators...
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As we shared with nursing center members on March 8, VHCA-VCAL has worked closely with the Department of Medical Assistance Services (DMAS) to find a...
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On Thursday, the House of Delegates and Senate approved their respective budget bills setting the stage for them to head to a conference committee to...
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Earlier this month national media outlets gave extensive coverage to a report released by the Government Accountability Office (GAO) calling upon the Centers for Medicare...
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Nearly every conversation about the forthcoming biennial state budget includes mention of Medicaid expansion. As part of his out-going budget, former Gov. Terry McAuliffe included...
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On Sunday, February 18, the House Appropriations and Senate Finance Committees are slated to announce their respective budget proposals for the 2019 and 2020 state...
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[caption id="attachment_89009" align="alignright" width="300"] Delegates Aird, James, and Pillion[/caption] On February 1, VHCA-VCAL staff met with new members of the House Appropriations subcommittee on Health...
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Each year the Department of Medical Assistance Services (DMAS) collects wage data from nursing centers, which is used in the calculation of annual inflation factors...
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The Department of Medical Assistance Services has asked VHCA-VCAL to share the following message regarding emergency procedures related to screening requirements and transportation. Emergency procedures...
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On December 18, Gov. Terry McAuliffe introduced his final budget for his term as governor. Of particular importance to VHCA-VCAL members, the budget fully...
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We have become aware that providers are having difficulty with claims processing one of the CCC Plus managed care organizations (MCOs), Optima Health. Because Optima currently...
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On November 1, the Department of Medical Assistance Services released the Official Consensus Medicaid Forecast. Of immediate concern, DMAS has identified a funding shortfall of...
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The Department of Medical Assistance Services (DMAS) has asked VHCA-VCAL to share two updates with providers. First, beginning next week the agency will be substituting...
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On September 20, AHCA/NCAL hosted a member webinar to provide you with the details about why we must all work together to oppose the Graham/Cassidy...
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As Commonwealth Coordinated Care Plus (CCC Plus) continues its phased roll-out across the state, we wanted to provide two additional updates for the program this...
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The Central Region went live for coverage under Commonwealth Coordinated Care (CCC) Plus on September 1. Next up will be the Western/Charlottesville Region on October...
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Effective September 1, the Central Virginia region will go live for coverage under the roll out of the mandatory Medicaid long term services and support...
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We have reactivated the Issue Log first set up in 2015 to help track and resolve member problems with the Commonwealth Coordinated Care (CCC) Plus...
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On July 31, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for fiscal year (FY) 2018 Medicare payment rates and quality...
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In our continuing effort to keep you up-to-date on the developments related to the Commonwealth Coordinated Care (CCC) Program and the launch of CCC Plus,...
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Ascend Project Support Services requested that we notify you that it will now be offering providers in Virginia another option for resolving their assessment questions...
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In our continuing effort to keep you up-to-date on the developments related to the launch of the Commonwealth Coordinated Care (CCC) Plus program, we have...
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[caption id="attachment_80223" align="alignright" width="300"] Click picture for a larger view.[/caption] As August 1 approaches, we are inching closer to the beginning of the Commonwealth Coordinated...
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Senate Majority Leader Mitch McConnell (R-Kentucky) announced on June 27 that the Senate will delay the Affordable Care Act repeal and replace vote until after...
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The New York Times ran an article on June 24, Medicaid Cuts May Force Retirees Out of Nursing Homes, that profiled residents of Dogwood Village...
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Advocates are encouraged to contact their Senators and emphasize the importance of Medicaid funding for services to care for elderly and disabled Americans. The Senate...
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AHCA/NCAL is urging you to reach out to Senators Mark Warner and Tim Kaine to ensure Medicaid funding is preserved for America’s most frail and...
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On June 6, the Department of Medical Assistance Services (DMAS) posted an updated Medicaid rate file for fiscal year 2018. As we have reported in...
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DMAS has informed VHCA-VCAL that the promised RUGs history/comparison reports are now available through their eDoc Management system for each nursing center. To access your...
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On May 22, the White House released detailed department budgets. This is part of President Donald Trump's $4.1 trillion budget proposal for fiscal year (FY)...
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The U.S. Senate continues to work on its own "repeal and replace" plan, which could contain an unprecedented cut to Medicaid for America's most vulnerable individuals....
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Coming out of the 2017 General Assembly Session, VHCA-VCAL estimated that SFY 2018 nursing center Medicaid reimbursement would increase, relative to SFY 2017, by approximately...
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At a meeting of the Joint Subcommittee for Health and Human Resources Oversight, General Assembly leaders learned that the U.S. Senate is seeking feedback from...
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Read the latest from AHCA/NCAL President & CEO Mark Parkinson regarding the vote last week by the House of Representatives to repeal and replace the...
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On May 8 the Department of Medical Assistance Services (DMAS) issued a provider memo on the new direct and indirect operating base rates and an...
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This afternoon the U.S. House of Representatives passed the American Health Care Act repealing the Affordable Care Act. The measure passed on a 217-213 vote. ...
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On March 28 the Commonwealth Coordinated Care (CCC) Advisory Committee met to be briefed on the latest developments related to the shift to managed care...
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The Department of Medical Assistance Services (DMAS) is moving forward with the switch from the current RUG-III 34 grouper to the RUG-IV 48 grouper for...
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Cindi Jones, Director of the Department of Medical Assistance Services (DMAS), has issued a memo to providers on the Commonwealth Coordinated Care (CCC) Plus program,...
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A recording of the AHCA/NCAL webinar about the Medicaid reform provisions included in the "repeal and replace" of Obamacare legislation introduced in Congress this week...
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The Department of Medical Assistance Services (DMAS) is urging nursing centers to complete the required annual Medicaid wage survey as soon as possible. Don’t forget,...
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In mid-January, you should have received notice from the Department of Medical Assistance Services (DMAS) about the annual Medicaid wage survey participating nursing centers are...
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The House of Delegates and Senate are expected to vote today, February 24, to approve the proposed budget for the remainder of fiscal year (FY)...
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Message from Mark Parkinson, AHCA/NCAL President and CEO As Congress considers Medicaid reforms, “the future of our Medicaid funding faces its greatest threat in my...
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On February 9 the Department of Medical Assistance Services (DMAS) announced it has signed contracts with six managed care organizations (MCOs) to provide managed long...
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This week the House of Delegates and Virginia Senate passed their respective amendments to the biennial budgets. At this juncture, it appears that nursing centers...
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HB 2304, which proposes a series of reforms to the Medicaid program now includes language supported by VHCA-VCAL on how the Department of Medical Assistance...
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The Department of Medical Assistance Services (DMAS) announced this week that the CCC Plus implementation schedule had slipped one month from July 1, 2017 to...
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DMAS has announced that the protest period on the CCC Plus contract has ended. The agency has resumed activity on the contract procurement as of...
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To mitigate the negative impact of the nursing center rebasing, Del. John O’Bannon (R-Henrico) and Sen. Siobhan Dunnavant (R-Henrico) introduced budget amendments on behalf of...
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Facilities that have been Medicare-certified for at least one year are eligible to participate in a pilot study on two Transfer of Health Information and...
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DMAS has notified CCC Plus stakeholders that following its notice of intent to award the Medicaid Long Term Services and Supports (MLTSS) contract, the agency...
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On December 22, the Department of Medical Assistance Services (DMAS) issued its “Notice of Intent to Award” Commonwealth Coordinated Care Plus (CCC Plus) contracts to...
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VHCA-VCAL provided detailed comments and posed numerous questions to DMAS in response to the agency’s comment period on the Commonwealth Coordinated Care (CCC) Plus draft...
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Earlier this week the Department of Medical Assistance Services (DMAS) released a draft of the contract it will use with each of the managed care...
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On Friday morning Gov. Terry McAuliffe will address a joint meeting of the House Appropriations and Senate Finance Committees to outline his proposed amendments to...
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As DMAS continues its negotiations with seven health plans for participation in the Commonwealth Coordinated Care Plus (CCC Plus) Medicaid managed care plan, you may...
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On September 21, 2016 the Department of Medical Assistance Services (DMAS) announced it had narrowed the field of prospective managed care plans for the newly...
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CMS has posted a document that provides responses to some MDS-specific questions that were received during the Skilled Nursing Facility Quality Reporting Program (SNF QRP)...
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[caption id="attachment_75475" align="alignright" width="300"] Photo courtesy of the U.S. Senate Special Committee on Aging[/caption] The leaders of the U.S. Senate Special Committee on Aging have...
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On August 25, CMS published the current MDS 3.0 RAI Manual v1.14 and MDS forms, effective October 1, 2016. This updated version of the MDS...
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Governor Terry McAuliffe has announced that Virginia is facing a $1.5 billion state budget shortfall due largely to lower-than-expected income and sales tax collections. The...
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Two townhalls for providers in Martinsville, Henry County and Mecklenburg County are set to provide information on auto-enrollment in the Commonwealth Coordinated Care (CCC) as...
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Anthem HealthKeepers, has achieved network adequacy in Mecklenburg making it the second plan to obtain network adequacy there following Humana’s announcement regarding its network adequacy...
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The Department of Medical Assistance Services (DMAS) released a Medicaid Memo on July 19, 2016 alerting nursing centers that beginning August 1, 2016, enrollment reports...
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Last September the Department of Medical Assistance Services (DMAS) issued guidance indicating that Occurrence Code 50 is required on custodial Medicaid nursing facility claims. While...
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As many as 21 health plans formally expressed interest in Managed Long Term Services and Supports (MLTSS), the new statewide managed care delivery system, which...
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The Centers for Medicare & Medicaid Services (CMS) has issued a lengthy proposed rule aimed at expanding bundled payments in the Medicare program. The new rule,...
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AHCA has shared guidance and resources and resources from the U.S. Department of Health and Human Services' (HHS) Office for Civil Rights (OCR) to assist...
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According to the Department of Medical Assistance Services (DMAS), the fix to the patient pay calculation/communication issue in the new eligibility system was implemented over...
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VHCA has been informed that Humana has achieved network adequacy in Mecklenburg County. Previously, Mecklenburg County had no active Medicare/Medicaid Plans (MMPs). With the addition...
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The Centers for Medicare & Medicaid Services (CMS) has issued the final Medicaid managed care regulations. This is the first update to the regulations governing...
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Earlier this week the General Assembly returned to Richmond for its reconvened session to consider Gov. Terry McAuliffe’s actions on the budget and other bills....
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The General Assembly took up the budget conference report today, March 11, to finalize the funding plans for fiscal years (FYs) 2017-2018. Nursing centers will...
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Thirteen legislators—seven senators and six delegates—are meeting to reconcile the differences between the House and Senate budgets before the General Assembly adjourns. This week VHCA-VCAL...
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This week the House of Delegates and Senate approved their respective budget proposals and sent the measures to a conference committee to negotiate the differences....
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VHCA staff has been fielding a number of calls and e-mails regarding issues with patient pay corrections not being done timely or not at all...
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Effective December 1, 2015, the Department of Medical Assistance Services (DMAS) no longer accepts paper Uniform Assessment Instruments (UAI). DMAS has completed the transition from...
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Del. John O’Bannon (R-Henrico) has introduced two budget amendments on behalf of the Virginia Health Care Association and the Virginia Center for Assisted Living (VHCA-VCAL.) ...
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The General Assembly convened in Richmond for its 2016 session on Wednesday, January 13. Legislators are scheduled to meet for 60 days this year and...
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VHCA has offered comments to the Department of Medical Assistance Services (DMAS) on two reforms of the Medicaid program with impact on nursing centers. The...
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Gov. Terry McAuliffe presented his biennial budget today. For the first time, the Commonwealth’s 2-year spending proposal will exceed $100 billion dollars. While the governor...
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Humana/ILS sent letters to providers last week indicating that it is migrating to a new back-end claims processing system on December 1 for Commonwealth Coordinated...
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VHCA was invited to provide public comments before the Provider Assessment Work Group on October 28. The work group is analyzing the options for creating...
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