What types of policy changes does Virginia Medicaid - DMAS issue?

Virginia Medicaid - DMAS regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Virginia Medicaid - DMAS update its policies?

Virginia Medicaid - DMAS typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Virginia Medicaid - DMAS policy changes are tracked here?

This page currently tracks 17 documented Virginia Medicaid - DMAS policy changes. New items are added as they are identified.

What should I do when Virginia Medicaid - DMAS changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Virginia Medicaid - DMAS Policy Changes & Prior Auth Updates

We track 17 documented policy changes from Virginia Medicaid - DMAS across VA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Virginia Medicaid - DMAS notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Virginia Medicaid - DMAS updates automatically.

Medium impact
Telehealth Services Supplement Update
Virginia Medicaid - DMAS·Effective Jan 5, 2026
Virginia DMAS expanded remote patient monitoring coverage for high-risk pregnant patients to explicitly include those with maternal diabetes and maternal hypertension. The updated Telehealth Services Supplement now lists 14 specific qualifying diagnoses and conditions for 6-month coverage authorization.
High impact
Update to Chapter II of the Hospice and Nursing Facilities Provider Manual
Virginia Medicaid - DMAS·Effective Dec 1, 2025
Virginia Medicaid has implemented new risk screening requirements for hospice providers effective December 1, 2025, requiring high-risk screening for initial enrollment and ownership changes, and moderate-risk screening for revalidations. Providers must maintain current enrollment in the Provider Services Solution (PRSS) portal to avoid claim payment disruptions.
Medium impact
Update to Pharmacists as Providers (PAP) Supplement in Pharmacy Manual
Virginia Medicaid - DMAS·Effective Jan 6, 2026
Virginia Medicaid updated its Pharmacists as Providers (PAP) policy to allow pharmacists to provide telehealth services and added billing for CLIA waivered HIV antibody testing. Providers must ensure enrollment information is current in the DMAS Provider Services Solution (PRSS) system to avoid claim payment disruptions.
Medium impact
Hospital Manual Update for Certain Long-Acting Injectables by any Hospital Emergency Department or Hospital Inpatient Setting Effective July 1, 2025
Virginia Medicaid - DMAS·Effective Jul 1, 2025
Effective July 1, 2025, Virginia Medicaid will provide separate payment for FDA-approved long-acting injectable medications for mental illness or substance use disorders administered in hospital emergency departments or inpatient settings, unbundled from the hospital daily rate. Providers must ensure their enrollment and contact information is current in the DMAS Provider Services Solution (PRSS) to avoid claims payment disruptions.
Medium impact
Update to Emergency Medicaid Supplement
Virginia Medicaid - DMAS·Effective Jan 26, 2026
Virginia Emergency Medicaid Supplement has been updated to clarify coverage for organ transplants, routine prenatal/postpartum care, and sterilization procedures for non-resident aliens. The policy emphasizes that providers must maintain current enrollment and contact information in the PRSS portal to avoid claim payment disruptions.
Low impact
Civil Money Penalty (CMP) Reinvestment Program Funding Opportunity and New Standardized Application Requirements
Virginia Medicaid - DMAS·Effective Jan 28, 2026
Virginia DMAS announced a Civil Money Penalty (CMP) Reinvestment Program funding opportunity for projects improving nursing facility care quality, with applications accepted February 2-27, 2026. The program uses standardized CMS application forms and requires submission through Virginia's eVA procurement system.
High impact
Clarification on Intellectual and Developmental Disability Targeted Case Management and FAMIS
Virginia Medicaid - DMAS·Effective Jan 30, 2026
Virginia Medicaid clarifies that Intellectual and Developmental Disability targeted case management services (codes T2023 and T1017) are only covered for Medicaid members, not FAMIS benefit plan members. Claims for FAMIS members will be denied, and providers must verify eligibility before providing services.
Medium impact
Home and Community-Based Settings (HCBS) Rule Compliance Post December 31, 2025
Virginia Medicaid - DMAS·Effective Feb 10, 2026
Virginia Medicaid has transitioned from initial HCBS compliance reviews to ongoing monitoring for developmental disability providers. A new Home and Community Based Compliance Portal launches February 7, 2026, requiring mandatory participation in HCBS reviews for group homes, residential settings, employment and day services.
Medium impact
Updates to Chapter 4 of the Pharmacy Provider Manual
Virginia Medicaid - DMAS·Effective Mar 4, 2026
Virginia Medicaid updated Chapter 4 of the Pharmacy Provider Manual with administrative changes including web hyperlink updates, Virginia Code references, and Preferred Drug List language. The policy emphasizes that providers must keep their enrollment and contact information current in the Provider Services Solution (PRSS) system to avoid claim payment disruptions.
Medium impact
Updates to Department of Behavioral Health and Developmental Services (DBHDS) licensing of Multisystemic Therapy (MST) providers and DMAS Enrollment
Virginia Medicaid - DMAS·Effective Mar 31, 2026
Virginia's Department of Behavioral Health and Developmental Services (DBHDS) is transitioning all Multisystemic Therapy (MST) providers from Intensive In-Home licenses to Mental Health Outpatient licenses by March 31, 2026. DMAS will automatically update provider licenses in their system, requiring no immediate action from providers, but MST providers must maintain both DBHDS licensing and MST Services Inc. certification to continue Medicaid reimbursement.
Medium impact
Virginia Medicaid Preferred Drug List / Common Core Formulary and New Drug Utilization Board Approved Drug Service Authorizations Effective April 1, 2026
Virginia Medicaid - DMAS·Effective Apr 1, 2026
Virginia Medicaid updated its Preferred Drug List (PDL) and Common Core Formulary effective April 1, 2026, adding new prior authorization requirements for 22 traditional and physician-administered drugs, and changing preferred status for multiple drug classes including antipsychotics, muscle relaxants, and bone resorption agents.
Medium impact
Updates on Continuity of Care from the Commonwealth Coordinated Care Plus (CCC Plus) Waiver to a Developmental Disabilities Waiver
Virginia Medicaid - DMAS·Effective Mar 31, 2026
Virginia Medicaid has updated the continuity of care process for individuals transitioning from the Commonwealth Coordinated Care Plus (CCC Plus) Waiver to Developmental Disabilities Waivers, expanding coverage to include respite, PERS, and private duty nursing services. The policy requires DD waiver services to start on the first of the month following acceptance, with a 30-day continuity period and specific documentation requirements.
High impact
New Single Sign-On Requirement for FFS Service Authorization Requests with Acentra ANG Platform Through DMAS MES Effective April 27, 2026
Virginia Medicaid - DMAS·Effective Apr 27, 2026
Starting April 27, 2026, Virginia Medicaid providers must use a new Single Sign-On process through the DMAS MES system to submit fee-for-service prior authorization requests to Acentra ANG platform. Direct access to ANG will be discontinued on June 1, 2026, making the MES portal the only method for FFS service authorizations.
Medium impact
Changes to Member Demographic Updates Requests
Virginia Medicaid - DMAS·Effective May 22, 2026
Virginia Medicaid is launching a new Demographic Correction Portal (DCP) on May 22, 2026, replacing the current email-based process for submitting member demographic update requests. LTSS screeners must stop using the patientpay@dmas.virginia.gov email and switch to the secure portal accessible through the PRSS provider portal.
Medium impact
Taxonomy Updates for ARTS Residential Services
Virginia Medicaid - DMAS·Effective May 1, 2026
Virginia Medicaid is discontinuing taxonomy code 320600000X for ARTS residential treatment providers effective May 1, 2026, replacing it with 324500000X (Substance Abuse Rehabilitation Facility) or 3245S0500X (Substance Abuse Treatment, Children). Provider enrollments have been automatically updated and no action is required by providers.
Medium impact
Behavioral Health Services Redesign Implementation Date Change
Virginia Medicaid - DMAS·Identified Jun 16, 2026
Virginia Medicaid has delayed the implementation of its Behavioral Health Services Redesign from July 1, 2026 to an unspecified future date due to legislative changes. Four current services will be retired and replaced with five new services, but the timeline is now uncertain pending the state budget process.
Medium impact
Virginia Medicaid Drug Utilization Review Board Approved Updates and Preferred Drug List Effective July 1, 2026
Virginia Medicaid - DMAS·Effective Jul 1, 2026
Virginia Medicaid updated their Preferred Drug List and prior authorization requirements effective July 1, 2026, adding new preferred drugs and moving some brand name drugs to non-preferred status. Billing teams must verify current prior authorization requirements for affected medications and update systems to reflect the new formulary changes.

Virginia Medicaid - DMAS in VA Virginia Medicaid - DMAS: Emergency Medicine Virginia Medicaid - DMAS: Endocrinology Virginia Medicaid - DMAS: Family Medicine Virginia Medicaid - DMAS: General Practice All payers

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Telehealth Services Supplement Update

Update to Chapter II of the Hospice and Nursing Facilities Provider Manual

Update to Pharmacists as Providers (PAP) Supplement in Pharmacy Manual

Hospital Manual Update for Certain Long-Acting Injectables by any Hospital Emergency Department or Hospital Inpatient Setting Effective July 1, 2025

Update to Emergency Medicaid Supplement

Civil Money Penalty (CMP) Reinvestment Program Funding Opportunity and New Standardized Application Requirements

Clarification on Intellectual and Developmental Disability Targeted Case Management and FAMIS

Home and Community-Based Settings (HCBS) Rule Compliance Post December 31, 2025

Updates to Chapter 4 of the Pharmacy Provider Manual

Updates to Department of Behavioral Health and Developmental Services (DBHDS) licensing of Multisystemic Therapy (MST) providers and DMAS Enrollment

Virginia Medicaid Preferred Drug List / Common Core Formulary and New Drug Utilization Board Approved Drug Service Authorizations Effective April 1, 2026

Updates on Continuity of Care from the Commonwealth Coordinated Care Plus (CCC Plus) Waiver to a Developmental Disabilities Waiver

New Single Sign-On Requirement for FFS Service Authorization Requests with Acentra ANG Platform Through DMAS MES Effective April 27, 2026

Changes to Member Demographic Updates Requests

Taxonomy Updates for ARTS Residential Services

Behavioral Health Services Redesign Implementation Date Change

Virginia Medicaid Drug Utilization Review Board Approved Updates and Preferred Drug List Effective July 1, 2026