Behavioral Health and Addiction Recovery Treatment Details

CCC Plus – Elite Plus

Virginia Premier has entered into an agreement with Beacon Health Options to implement a behavioral health and substance use management program for our CCC Plus members. Effective January 2018, all behavioral health and substance use services including Community Mental Health Rehabilitation Services (CMHRS) authorizations are administered by Beacon Health Options.

Beacon accepts requests for inpatient psychiatric admits, behavioral health partial hospital program requests, and behavioral health intensive outpatient program requests. For all such requests for Virginia Premier Elite Plus members, please call Beacon at:

Phone: 844-513-4951

For any behavioral health authorizations – including Addiction Recovery Treatment Services (ARTS) and CMHRS – please direct your requests to Beacon at the number below, along with the Department of Medical Assistance Services (DMAS) service authorization form. Note that Beacon only accepts these requests by fax:

Fax: 1-888-237-3997

Beacon bases all behavioral health service determinations on medical necessity/level of care (LOC) criteria accessible online at www.beaconhealthoptions.com.

Medallion – Elite Individual

Effective August 1, 2018, Community Mental Health and Rehabilitation Services (CMHRS) and Addiction Recovery Treatment Services (ARTS) provided for Medallion 4.0 members will be authorized and covered through Virginia Premier.

Authorizations for Virginia Premier Medallion members receiving CMHRS and ARTS can be obtained via:

Phone: 1-800-727-7536
Fax: 1-804-343-0304
Web Portal: https://www.virginiapremier.com/providers/medicaid/provider-portals/

Virginia Premier bases all behavioral health service determinations on medical necessity/level of care (LOC) criteria.

Service Authorization Requests

Service authorization forms for ARTS and CMHRS are accessible on the Department of Medical Assistance Services Webpage:

In the grid of CMHRS services below:

A indicates a service that requires an authorization
R indicates a service that requires a registration
Community Mental Health Rehabilitation Services Procedure
Code
Registration
vs
Authorization
Initial
Request
Registration
vs
Authorization
Continued Stay
Request
Mental Health Case Management H0023 R R
Mental Health Peer Support Services – Individual H0025 R A
Mental Health Peer Support Services – Group H0024 R A
Crisis Intervention H0036 R A
Crisis Stabilization H2019 R A
Intensive Community Treatment H0039 A R
Intensive In-Home H2012 A A
Therapeutic Day Treatment (TDT) for Children *TDT School Day H0035
HA
A A
Therapeutic Day Treatment (TDT) for Children *TDT Afterschool H0035
*HA *UG
A A
Therapeutic Day Treatment (TDT) for Children *TDT Summer H0035
*HA *U7
A A
Day Treatment/Partial Hospitalization *Adults H0035
*HB
A A
Mental Health Skill-building Services (MHSS) H0046 A A
Psychosocial Rehab H2017 A A
EPSDT Behavioral Therapy (ABA) H2033 A A

* For More information regarding Behavioral Health Services Coverage please read our Provider Manual chapter on Mental Health Services.

Behavioral Health Services Administrator (BHSA)

Magellan of Virginia serves as the behavioral health services administrator (BHSA) for Virginia Premier and is responsible for the management and administration of the behavioral health benefit programs under contract with DMAS.

Magellan works with individuals::

  • receiving fee-for-service Medicaid benefits
  • on the Governor’s Access Plan (GAP)
  • children receiving any Medicaid benefit in need of residential treatment services (including therapeutic group homes)

For more information about Magellan of Virginia, please contact them at 800-424-4536 or VAProviderQuestions@MagellanHealth.com.

Effective April 1, 2019, Virginia Premier will be managing psychiatric residential treatment facility (PRTF) services, therapeutic group home (TGH) and treatment foster care-case management services. Until that date, these services will be carved out of Medallion 4.0 coverage, and administered through Magellan of Virginia.