MedicaidCoverageMedium 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·VA · Emergency Medicine, Psychiatry·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jun 16, 2026
Summary
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.
Action Required
By July 1, 2025: Hospital billing teams must update billing systems to separately bill FDA-approved long-acting injectable medications for mental illness and substance use disorders, unbundling these from hospital daily rates. All providers must verify and update enrollment, contact information, and license information in the DMAS Provider Services Solution (PRSS) portal to prevent claims denials.