KEPRO Service Authorization Process Waiver Services

1. KEPRO Service Authorization ProcessWaiver Services Technology Assisted Waiver

2. New Health Coverage for Adults in Virginia • Beginning January 1, 2019, more adults living in Virginia will have access to quality, low-cost health insurance. The new coverage includes hospital stays, doctor visits, preventive care, prescription drugs and much more! • The rules have changed! So, if you applied for Medicaid in the past and were denied, you may soon be eligible. Eligibility is based on income, with a single adult making up to $16,754, or a family of three making up to $28,677, qualifying for coverage. • Interested in learning more? • Check out the below resources or visit www.coverva.org for more information and details on eligibility. • Coverage for Adults Brochure (PDF) • Coverage for Adults Flyer (PDF) • FAQs - New Adult Eligibility for Health Coverage (PDF) • Coverage for Adults Poster (PDF)

3. GAP (GOVERNOR’S ACCESS PLAN) • As part of Medicaid Expansion, On January 1, 2019, Virginia Medicaid will offer new health coverage for adults. Most Governor’s Access Plan (GAP) members will be enrolled automatically in this new program. • If the member has any questions about the new health coverage for adults, or if they need to provide notification of a change in where they live, mailing address, phone number, change of income or health insurance coverage, please contact Cover Virginia GAP Processing Unit at 855-869-8190.

4. Methods of Submission Service Authorization Requests to KEPRO • Please note that for Technology Assisted Wavier, all requests must be submitted via KEPRO’s Atrezzo Connect System effective 9/1/2015. Reference the DMAS Medicaid Memo dated 6/15/2015, “Notification that KEPRO is Converting to Electronic Process for Submitting Service Authorization Requests – Effective September 1, 2015.” • To access Atrezzo Connect on KEPRO’s website, go to http://dmas.KEPRO.com. • Provider registration is required to use Atrezzo Connect. • The registration process for providers happens immediately on-line • From http://dmas.KEPRO.com, providers not already registered with Atrezzo Connect may click on “Register” to be prompted through the registration process. Newly registering providers will need their 10-digit National Provider Identification (NPI) number and their most recent remittance advice date for YTD 1099 amount. • If you are a new provider who has not received a remittance advice from DMAS, please contact KEPRO at 1-888-827-2884 or atrezzoissues@kepro.com to receive a registration code which will allow you to register for KEPRO’s Atrezzo Connect Portal. • The Atrezzo Connect User Guide is available at http://dmas.KEPRO.com:  Click on the Training tab, then the General tab.

5. Service Authorization Requests: Contact Information for KEPRO/ DMAS Provider Information • Providers with questions about KEPRO’s Atrezzo Connect Provider Portal may contact KEPRO by email at atrezzoissues@kepro.com. • For service authorization questions, providers may contact KEPRO at providerissues@kepro.com. • KEPRO may also be reached by phone at 1-888-827-2884, or via fax at 1-877-OKBYFAXor 1-877-652-9329.

6. Service Authorization Process • DMAS publishes electronic and printable copies of its Provider Manuals and Medicaid Memoranda on the DMAS Web Portal at https://www.virginiamedicaid.dmas.virginia.gov/wps/portal. • This link opens up a page that contains all of the various communications to providers, including Provider Manuals and Medicaid Memoranda. • The Internet is the most efficient means to receive and review current provider information.

7. Service Authorization Process Service Authorization (SrvAuth) Submission Requirements for the following Waiver Service Type: • Technology Assisted Wavier (TW) - 0960

8. Service Authorization Process • The Provider verifies eligibility by using the DMAS web based ARS system at: • https://www.virginiamedicaid.dmas.virginia.gov/wps/portal • or by calling: • Medicall at 1-800-884-9730 or 1-800-772-9996

9. Submitting SrvAuth Requests • Requests should be submitted via: • AtrezzoConnect http://dmas.KEPRO.com(registration required) • For any questions regarding the submissionofSrvAuth requests please contact KEPROat888-827-2884 or 804-622-8900.

10. Covered Services Under Technology Assisted Waiver (TW)- 0960 • Environmental Modifications (S5165) and Environmental Modifications Maintenance (99199 U4) • Assistive Technology (T1999) and Assistive Technology Maintenance (T1999U5) • All other services authorized by DMAS. • The SrvAuth is end-dated 30 days from the approved “date from” (Start of Care date) in the VAMMIS system.

11. Covered Services Under Technology Assisted Waiver (TW) - 0960 (cont’d) • Maximum Medicaid funded expenditure is $5,000.00 per calendar year for all Environmental Modifications (EM) and Assistive Technology (AT) codes combined (i.e. $5,000.00 for EM codes and $5,000.00 for AT codes). • May have multiple items requested within the calendar year by the same or different provider, but can not exceed $5,000.00. • Cost cannot be carried over from one calendar year to another.

12. Covered Services Under Technology Assisted Waiver (TW) - 0960 (cont’d) • Dates of Service authorized cannot cross over calendar years. • This service does not include items covered in the State Plan for Medical Assistance as a Durable Medical Equipment and Supplies or through another program. • Request may be submitted by DME providers, or Nursing Agencies (If by Nursing Agencies, a DME provider number is required).

13. Environmental Modifications – S5165 and 99199 U4 • Service is available to individuals who are enrolled in and receiving Technology Assisted Waiver services. • Submitted documentation must include the description of the item, cost of materials, labor and must provide direct medical or remedial benefit to the individual.

14. Environmental Modifications (EM) – S5165 and 99199 U4 (cont’d) • Modification can not be duplicated. • EM can not be authorized to bring substandard dwelling up to minimum habitation standards. • EM must not increase square footage of residence.

15. Assistive Technology (AT) – T1999 and T1999U5 • Service is available to individuals who are enrolled in and receiving Tech Waiver services. • Assistive Technology must be portable.

16. Assistive Technology (AT) - T1999and T1999U5 (cont’d) • May have multiple items requested within the calendar year by the same or different provider but can not exceed $5,000.00. • Documentation must include the name and title of the qualified professional who recommended the AT via a therapeutic evaluation, to include a statement to the need and medical necessity for the purchase.

17. Assistive Technology (AT) - T1999and T1999U5 (cont’d) • Dates of Service authorized cannot cross over calendar years. • Items can not be duplicated or rented. • Must be medically necessary, cost effective, and not for educational purposes only.

18. Skilled Respite –S9125 (TD) S9215 (TE ) • TW respite applies to agency directed skilled nursing respite care RN (S9125 TD) and agency directed skilled nursing respite care LPN (S9125TE). • The service authorization for this waiver is contingent upon the approval for Skilled Private Duty Nursing services by DMAS on the SrvAuth file in VaMMIS. The member must be enrolled in the TW on the LOC ‘A’ in the DMAS SrvAuth system before processing Respite service requests.

19. Skilled Respite –S9125 (TD) S9215 (TE ) • Service approval dates must fall between the dates of the LOC ‘A” segment. • A Maximum of 360 hours may be authorized per calendar year. • There must be an unpaid primary caregiver. • The provider can submit at anytime once the PDN authorization has been completed by DMAS TW staff. However, the provider must submit within 10 business days of start of care for respite services

20. Submitting Additional Information • If upon review of the documentation submitted for a SrvAuth request is determined to be insufficient to process the request, the Clinical Reviewer will “pend” the request for the additional information. • To submit additional information on a pended case: • Via Atrezzo Connect- • Providers must submit additional information through Atrezzo Connect by choosing "add to comments” if documents are needed. Provider will need to upload the documents to Atrezzo by using the “Upload Attachments” feature. (NOTE: The "extend case" feature is used when requesting additional days of coverage only). Whenever a provider adds to comments, this puts the case back in the nurse review queue.

21. Submitting Changes to an Existing Case (for all formats) • If the request is for a discharge – please request under the existing case number to be discharged. You will need to enter a discharge note in the clinical note section of the case. Do not create a new case. • If the request is for a change (increase or decrease) in dates, units, or hours, please request under the existing case number, do not open a new case for these types of requests. • Requesting or creating new cases in place of updating existing cases only delays processing time and causes duplicate and overlapping date errors. • There are no automatic renewals of service authorizations. • Providers must submit requests for continuation of care needs, with supporting documentation, prior to the expiration of the current authorization.

22. Reference Materials • Technology Assisted Waiver and Private Duty Nursing Services Manual Chapter IV and Appendix D • Training Information, SrvAuth educational resources & DMAS Manuals at: http://dmas.KEPRO.com

23. General Information for All Service Authorization Submissions • There are no automatic renewals of service authorizations. • Providers must submit requests for continuation of care needs, by completing the questionnaire, prior to the expiration of the current authorization. • Providers must verify member eligibility prior to submitting the request. • Authorizations will not be granted for periods of member and/or provider ineligibility. • Providers must submit a service authorization request under the appropriate service type. Service authorization requests cannot be bundled under one service type if the service types are different.

24. VIRGINIA MEDICAID WEB PORTAL • DMAS offers a web-based Internet option to access information regarding Medicaid or FAMIS member eligibility, claims status, check status, service limits, service authorizations, and electronic copies of remittance advices.  • Providers must register through the Virginia Medicaid Web Portal in order to access this information. The Virginia Medicaid Web Portal can be accessed by going to: www.virginiamedicaid.dmas.virginia.gov.

25. DMAS Helpline Information AND/OR RESOURCES • The “HELPLINE” is available to answer questions Monday through Friday from 8:00 a.m. to 5:00 p.m., except on holidays. • KEPRO Website https://dmas.KEPRO.com. • DMAS web portal https://www.virginiamedicaid.dmas.virginia.gov. • For any questions regarding the submission of Service Authorization requests, please contact KEPRO at 888-827-2884 or 804-622-8900. • For claims or general provider questions, please contact the DMAS Provider Helpline @ 800-552-8627 or 804-786-6273.

26. THANK YOU THANK YOU!