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NEW! EFFECTIVE April 1, 2014 Commonwealth Coordinated Care Coverage

Commonwealth Coordinated Care Coverage begins for those who voluntarily enrolled in the Tidewater and Central VA region!!

 

DMAS is pleased to announce the launch of Commonwealth Coordinated Care (CCC), a new initiative to blend and coordinate Medicare and Medicaid services for Virginians receiving both benefits. CCC offers care coordination services and supplemental benefits not currently available to individuals receiving traditional Medicare and Medicaid benefits. Eligible individuals will receive a letter notifying them of their CCC eligibility. For more information on eligibility and CCC services , please visit the CCC webpage at http://www.dmas.virginia.gov/Content_pgs/altc-enrl.aspx . Individuals enrolled in CCC will have all services authorized by the Medicare-Medicaid Plan (MMP) they have chosen: Healthkeepers, Humana, or Virginia Premier. For CCC enrollees, contact the MMP directly for service authorization information.


Posted: 3/28/2014

NEW Changes will be implemented for EDCD waiver and Technology waiver respite authorizations

New changes will be implemented in the Elderly and Disabled with Consumer Direction (EDCD) waiver and the Technology waiver respite service authorization.

  • Respite care service authorization will change from 12 month durations to 24 month durations for requests submitted for all new respite admissions, re-admissions and transfers received by KEPRO beginning March 1, 2014.
  • Requests for respite renewals will continue to be authorized  for 12 months by KEPRO for authorizations that end January 1, 2014 through April 30, 2014.
  • EDCD waiver only- In April 2014, Medicaid member with current respite authorizations that end may 1, 2014 through December 31, 2014 will receive an extended respite authorization. The respite authorization will be automatically extended to 2015 using the members birth month and day. This will be a one time extension to move respite renewals from the fiscal year, June 30th. Future Respite renewal end dates will be calculated based on the requested date which might not coincide with the birth month and date.
  • New respite change in 2015. All respite renewals, new admissions, readmissions, and transfers will be authorized for 24 months. Providers will need to submit a request for services to receive an authorization. This change includes respite services in EDCD waiver an the Technology waiver. There are no automatic renewals.
  • EDCD waiver only- July 1, 2014, providers may choose to align the personal care and respite services.

For more specific information detailing how the respite authorization changes will be implemented, refer to the Medicaid memo dated March 4, 2014 on the Provider Web Portal at: https://virginiamedicaid.dmas.virginia.gov/ under the provider Services tab.

Provider web based training session on the EDCD respite to personal care alignment process is scheduled  on June 3, 2014. click on the Training tab on this site for more information.


Posted: 3/6/2014

Behavioral Health Service Authorization Request Deadline

Attention Behavioral Health Providers.  KEPRO’s last day to receive Behavioral Health service authorization requests is November 30, 2013. All cases received on or before November 30, 2013 with a start date prior to December 8, 2013, will be processed by KEPRO. If you have a case that was pended by KEPRO you must respond back to KEPRO by the required timeframe noted on the pend request.  If you are submitting a request for a new admission or a continued stay request where the date of service begins on December 8, 2013 or later, you must submit that request to Magellan Health Services. Magellan will begin accepting requests December 1, 2013. After November 30, 2013 any new or continued stay requests will be processed by Magellan.  Please refer to the Department of Medical Assistance Services (DMAS) memo dated October 31, 2013-REVISED or the DMAS web site at http://www.dmas.virginia.gov/ for Magellan Health Services contact information.  You may also contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273.
Posted: 10/30/2013

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Service Authorization (Srv Auth) Checklists

Want to avoid hold-ups caused by missing information in Srv Auth requests? Check out the Required Srv Auth Information Checklists. These handy reference lists will help you determine at a glance all the information required for each service type.

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KEPRO is URAC accredited in Health Utilization Management, Disease Management and Case Management. We are also licensed to perform medical reviews in 29 states.

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