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Virginia Medicaid - DMASMedicaid · Coverage · Specialty Services · VA · PsychiatryHigh impact

Behavioral Health Services Redesign Implementation Dates

Act
by Jun 30, 2027
Effective date
Jun 30, 2027
Identified
Sep 11, 2026

Summary

Virginia Medicaid is redesigning behavioral health services, retiring four Community Mental Health Rehabilitative Services (CMHRS) codes (H2012, H2016, H0046, H2017) effective June 30, 2027, and implementing five new behavioral health service codes (CPST-Adult, CPST-Youth Community, CPST-Youth School, CSC, Clubhouse) effective July 1, 2027. All current members receiving the retiring services must transition to alternative behavioral health services by the deadline. The practice must update provider enrollment, verify credentials, and prepare for service authorization transitions over the next 6-12 months.

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What to do

by Jun 30, 2027 · 10 steps
01Billing team must stop billing retired HCPCS codes H2012 (Intensive In-Home Services), H2016 (Therapeutic Day Treatment), H0046 (Mental Health Skills Building), and H2017 (Psychosocial Rehabilitation).
02Before July 1, 2027.
03Verify all current patient rosters to identify members receiving these four services.
04Coordinate with Acentra Health and Cardinal Care MCOs to transition all affected members to replacement services.
05Update billing system to recognize new service codes effective July 1, 2027.
06Ensure provider enrollment, contact information, and licenses are current in PRSS (Provider Services Solution) portal to avoid claims payment disruption—MCOs and DMAS are prohibited from paying claims to non-enrolled network providers.
07Review draft manuals and attend provider training sessions on the new standardized assessment (CANS Lifetime) and Level of Need Model.
08Contact DMAS Behavioral Health Division at enhancedbh@dmas.virginia.gov or attend open office hours for transition questions.
09Consequences: Claims for retired services will be denied after June 30, 2027.
10Claims for services billed by non-enrolled providers will not be paid by MCOs or DMAS.

Codes mentioned

H2012H2016H0046H2017

Original notice

Behavioral Health Services Redesign Implementation Dates
vamedicaid.dmas.virginia.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Virginia Medicaid - DMAS policiesVA policy changesPsychiatryCode H2012Code H2016Code H0046Code H2017

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