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Virginia Health Care Association | Virginia Center for Assisted Living

Submit April Roster Billings for Medicaid $20/Day by May 8

Submit April Roster Billings for Medicaid $20/Day by May 8

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 22. You can submit your files after May 8, but payment may be delayed. Since the initial implementation information was provided last week, DMAS has shared additional guidance members had on questions related to specialized care, hospice, and PACE.

  • Specialized Care: If you are a specialized care provider, you should submit separate spreadsheet(s), not a tab in the same sheet, for your specialized care days for FFS and each MCO. Make sure you use the appropriate NPI on the sheet. If you included the specialized care days combined with NF days for the March period do not worry about it, but please use this new approach for April rosters going forward. DMAS states that the MCOs will be made aware of the procedure with specialized care.
  • Hospice: DMAS advises that NFs should not bill FFS hospices for the FFS $20 add-on—only do your normal rate billing. DMAS indicates that the hospices will be given a payment schedule to provide the $20 per day add-on to the NFs outside of the normal NF to hospice billing. DMAS does not have specifics on when to expect the hospices to provide the payment, but it should be one to two weeks after the hospices receive the payment form DMAS. None of this matters for the MCO roster billing, which should include hospice days on the same tab as NF days.
  • PACE: Days for individuals residing in NFs who participate in the PACE program are eligible for the $20 per day add-on. DMAS has stated that the NF should create a “PACE” tab or tabs on the FFS roster template using a hospice tab as the model (this is not relevant to the MCO template as you cannot be in PACE if you are in CCC Plus). DMAS indicates that they are still working out the details on payments for the PACE days, but this is how the days should be submitted. At this time, it is not clear when and from whom (the PACE or DMAS) payment will be received.

More information about the process for implementing the add-on is available in our April 27 update.

DMAS Guidance and Templates