Community Stabilization Coverage Change and Mobile Crisis Response Policy Change

REQUIREMENTS: 1. IMMEDIATE (Now): Billing team must monitor the Virginia Medicaid website (https://vamedicaid.dmas.virginia.gov/) and PRSS provider portal for the official effective date announcement for both service changes. The policy states end dates will be announced in a subsequent notice. 2. BEFORE effective date for Community Stabilization elimination: Billing team must remove CPT equivalent for S9482 from all billing configurations, encounter forms, and service authorization workflows. Update billing software to reject or flag any S9482 claims submitted on or after the announced effective date. Notify all behavioral health providers that S9482 will no longer be reimbursable. 3. BEFORE effective date for Mobile Crisis Response change: Billing team and clinical staff must update billing systems to enforce the new 4-hour per encounter limit for H2011 (reduced from 8 hours). Modify prior authorization templates and service authorization forms to reflect the reduced limit. Update provider documentation requirements to capture encounter duration accurately. 4. ONGOING: Ensure provider enrollment information in PRSS is current and verified for all service locations. Verify that all Mobile Crisis Response providers are DBHDS licensed and approved and contracted with community services boards, as required by regulation. Under federal rules, claims to non-enrolled providers will be denied by both FFS and MCOs. 5. CONTACT for clarification: Provider Helpline (804-786-6273 or 1-800-552-8627, Monday-Friday 8am-5pm) or Acentra Health at 1-804-622-8900 for behavioral health authorizations. CONSEQUENCES: Claims for S9482 will be denied after the effective date. Claims for H2011 exceeding 4 hours will be denied or reduced. Claims from non-enrolled providers will be denied regardless of service code.