MedicaidCoverageMedium impact
Youth Re-entry Targeted Case Management (RTCM) Implementation
Virginia Medicaid - DMAS·VA · Psychiatry·Specialty Services
Effective date
Jul 1, 2026
We identified it
Jul 22, 2026
Summary
Virginia Medicaid is launching a new covered service effective July 1, 2026: Re-Entry Targeted Case Management (RTCM) for adjudicated youth and young adults (under 21, or up to 26 if former foster care) transitioning from incarceration. RTCM is a 3-month service (starting 30 days pre-release through 2 months post-release) carved out of managed care and billed as fee-for-service. Community Services Boards (CSBs) must enroll with Provider Class 156 or 456 and Specialty 923 to deliver this service.
Action Required
By June 30, 2026: (1) Verify if your organization operates a Community Services Board (CSB) eligible to provide case management services. (2) If yes, ensure CSB case managers are licensed by the Department of Behavioral Health and Developmental Services (DBHDS). (3) Providers must enroll in PRSS (Provider Services Solution) with Provider Class Type 156 or 456 and Provider Specialty 923; contact VAMedicaidProviderEnrollment@gainwelltechnologies.com or 1-888-829-5373 to complete enrollment before the effective date. (4) Billing team: Configure billing system to recognize RTCM as a fee-for-service (FFS) carved-out service that bypasses Cardinal Care Managed Care (CCMC) contracts—claims must route to DMAS FFS, not MCOs. (5) Update internal documentation and referral processes to identify eligible RTCM candidates (adjudicated youth within 30 days of release). (6) Train intake and billing staff on RTCM service parameters (assessment, ISP development, referral/care coordination, warm hand-off to CCMC care management). (7) Monitor PRSS regularly to keep enrollment, contact information, and license information current for all service locations; claims will be denied to providers not enrolled in PRSS. For questions, contact Reentry@dmas.virginia.gov.