MedicaidCoverageHigh impact
Behavioral Health Services Redesign Implementation Dates
Virginia Medicaid - DMAS·VA · Psychiatry·Specialty Services
Effective date
Jun 30, 2027
We identified it
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.
Action Required
By June 30, 2027: Billing 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). Before July 1, 2027: (1) Verify all current patient rosters to identify members receiving these four services; (2) Coordinate with Acentra Health and Cardinal Care MCOs to transition all affected members to replacement services; (3) Update billing system to recognize new service codes effective July 1, 2027; (4) Ensure 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; (5) Review draft manuals and attend provider training sessions on the new standardized assessment (CANS Lifetime) and Level of Need Model; (6) Contact DMAS Behavioral Health Division at enhancedbh@dmas.virginia.gov or attend open office hours for transition questions. Consequences: Claims for retired services will be denied after June 30, 2027. Claims for services billed by non-enrolled providers will not be paid by MCOs or DMAS.