MedicaidDocumentationHigh impact
CCC Plus Waiver Provider Manual Update, Chapters II and IV; New Appendix E, Extraordinary Care Guide; and DMAS-97A/B and DMAS-99 Forms Update
Virginia Medicaid - DMAS·VA · Occupational Therapy, Physical Therapy, Speech Therapy +2 more·Medical Policy
Effective date
Sep 2, 2026
We identified it
Sep 11, 2026
Summary
Virginia DMAS updated the CCC Plus Waiver Provider Manual (Chapters II and IV) with substantive changes to licensure requirements, criminal background checks, personal care documentation, and Plan of Care procedures. Two critical forms—DMAS-97A/B and DMAS-99—have been updated and must be adopted by October 1, 2026, or claims will be denied. Providers must also ensure enrollment information is current in the Provider Services Solution (PRSS) system to avoid claim payment disruptions.
Action Required
REQUIREMENTS:
By October 1, 2026: Billing team and all CCC Plus Waiver service providers must discontinue use of old DMAS-97A/B and DMAS-99 forms and transition to updated versions. Download new forms from the Medicaid Enterprise System (MES) website. Update billing system templates and encounter workflows to reflect new form requirements. Failure to use updated forms after this deadline will result in denial of all service authorization requests.
Immediately: Verify and update provider enrollment information (facility licenses, contact information, service locations) in the Provider Services Solution (PRSS) portal at https://vamedicaid.dmas.virginia.gov/. Contact Gainwell Technologies at VAMedicaidProviderEnrollment@gainwelltechnologies.com or 804-270-5105 (in-state) / 888-829-5373 (toll-free) if enrollment status is unclear. Outdated enrollment will result in claim denials from DMAS and all MCOs (Aetna, Anthem, Humana, Sentara, United Healthcare).
Before October 1, 2026: Billing staff and Services Facilitators must implement new documentation requirements: (1) Document time per task on all personal care Plans of Care; (2) Add backup plan explanations with more detail on DMAS-97A/B forms; (3) Ensure LRI (Labor Relations Initiative) personal care questions are answered on updated Plans of Care; (4) Confirm Start of Care date is documented by nurse/Services Facilitator during initial assessment, not on the DMAS-99 form (field removed); (5) Add questions about member care and support system, primary care visits, and LRI aides/attendants to DMAS-99 assessments.
Immediately for Managed Care Plans: Providers billing through Cardinal Care (Aetna, Anthem, Humana, Sentara, United Healthcare) must follow respective MCO contracts in addition to DMAS requirements. Review each MCO's provider network resources and prior authorization channels listed in the policy.