Medicare AdvantageAdministrativeMedium impact
[Virginia] LTSS providers: Respite authorizations auto‑renew for the new fiscal year; no action needed
Anthem BCBS·VA · Geriatrics, Palliative Care·Provider Bulletin
Effective date
Jun 1, 2026
We identified it
May 3, 2026
Summary
HealthKeepers, Inc. (Virginia Medicaid/Medicare Advantage) will automatically renew all respite care authorizations for active LTSS waiver members in June 2026 for the new fiscal year (July 2026–June 2027). Providers should NOT submit renewal requests; instead, they must report any members lacking respite authorization by June 9, 2026, and immediately notify HealthKeepers of member eligibility changes, benefit changes, or provider changes. New respite authorization forms (DMAS 97 A/B) are only needed when services start for the first time, during personal care renewals, or when switching providers after exhausting the 480-hour annual limit.
Action Required
By June 9, 2026: Billing and provider relations teams must identify any active LTSS waiver members without respite authorizations in place and submit a spreadsheet (member names and Anthem ID numbers) to pcaumteam@anthem.com. STOP submitting respite renewal requests for the new fiscal year—HealthKeepers will handle auto-renewal and duplicate submissions will delay processing. Implement a tracking system to monitor: (1) member eligibility changes (loss of Medicaid or waiver status), (2) respite benefit changes (e.g., legally responsible individuals becoming caregivers), (3) provider changes (including shared services or agency-to-consumer transitions). When a member exhausts 480 respite hours mid-fiscal year and transitions to a new provider, only the new provider submits DMAS 97 A/B requesting remaining hours for that fiscal year. Educate all clinical and billing staff that respite authorization forms are only required for first-time services, during personal care renewal submissions, or after provider changes post-hour depletion. Establish internal protocols to report changes to HealthKeakers immediately (contact: 800-901-0020 for Medicaid-only; 800-676-2583 for FIDE members). Failure to report changes promptly may result in service authorization delays or improper billing.