Notices & Announcements

Behavioral Health Program Announcement

New** As of January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) annual updates have resulted in changes to drug testing codes utilized by WV Medicaid. The Bureau for Medical Services (BMS) will follow the 2017 CMS coding guidelines for reporting drug testing procedures:

  • Presumptive testing codes 80305, 80306 and 80307 should be used instead of G0477, G0478, and G0479.
  • Only one of the three presumptive codes (80305, 80306, 80307) may be billed per day.
  • Only one of the four definitive codes (G0480, G0481, G0482, G0483) may be billed per day.
  • Only one service unit per procedure code per date of service may be billed when submitting (80305-80307, G0480-G0483, G0659).
  • Drug confirmation tests are no longer eligible to be separately reported under any procedure code, unlisted or otherwise. This service is considered included in the presumptive or definitive drug testing procedure codes (80305-80307, G0480-G0483, G0659).
  • Specimen validity testing is not eligible to be separately billed under any procedure code. The code description for (80305-80307, G0480-G0483, G0659) indicates that this testing is included if it was performed.

BMS policy requires a prior authorization for drug screenings performed for over the limit of 24 per calendar year. The HF modifier must continue to be included on all claims for these codes when related to substance abuse treatment (e.g. Suboxone).

The presentation on the 2017 Drug Testing Changes can be found here: 2017 Drug Codes Changes Webinar Presentation

New** The West Virginia Department of Health and Human Resources (WV DHHR) along with the Bureau for Medical Services (BMS) is pleased to announce West Virginia Licensed Professional Counselors (LPC) may enroll as Medicaid Providers beginning Mar 1, 2017. The following services have been approved by West Virginia Medicaid for LPCs to provide:

  • Psychiatric Diagnostic Evaluation without Medical Services (90791)
  • Individual Psychotherapy (90832, 90834, 90837)
  • Group Psychotherapy (90853)
  • Psychotherapy for Crisis (90839, 90840)
  • Family Psychotherapy (90846, 90847)

A draft manual is in development and will be posted on the BMS website for public comment in the near future. More information and registration guidelines will be posted as it comes available. 

 

New Webinars Announcement - Drug Screening - July 2018

Good Morning,

KEPRO would like to invite you to participate in our upcoming webinar for the new drug screening code changes effective July 1, 2018. We will be conducting 2 webinars-dates and times are listed below. We will be providing an overview of the policy and changes as well as providing detail on the process for requesting medical necessity authorization to exceed code limits. Please e-mail the completed registration form (attached) to wvmedicalservices@kepro.com with the date and time you wish to attend.  After the registration form is received, you will be sent a confirmation e-mail with the webinar information included.

Webinar Dates and Times:

Tuesday July 24, 2018 @ 9:00-11:00 am EST

Friday July 27, 2018 @ 1:00-3:00 pm EST

If you cannot attend one of the scheduled webinars, we will be uploading the PowerPoint being presented to the KEPRO website at http://wvaso.kepro.com.

Drug Screening Chapter 529.2 Comment Final

Drug Screening 2018 Codes Final

Drug Screening Policy Final

Drug Code Screen Webinar Registration Form

New** WV Medicaid has released documents pertaining to the Substance Use Disorder Waiver. As of July 1, 2018, Phase 1 and Phase 2 of the waiver are active.  In addition to the announcement letter, Adult residential rates are listed below along with the Peer Recovery memorandum.  The link to enrolling in the Public LMS Course DHHR provides info on accessing the Peer Recovery Certification Webinar

BMS SUD Waiver Adult Residential Treatment Services Rates Memorandum

DHHR Press Release 2018-6-28 Second Phase of SUD Services Implemented

Instructions for enrolling in Public LMS Course DHHR

Peer Recovery Support Webinar Memorandum 7.11.18

 

New** Can telehealth be utilized through a personal computer?

BMS’s response: Yes, as long as the individual’s personal computer has a VPN to the provider and the provider ensures that it is safe to render services through this modality for the member.

 

Medical Services Announcements

New** As of January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) annual updates have resulted in changes to drug testing codes utilized by WV Medicaid. The Bureau for Medical Services (BMS) will follow the 2017 CMS coding guidelines for reporting drug testing procedures:

  • Presumptive testing codes 80305, 80306 and 80307 should be used instead of G0477, G0478, and G0479.
  • Only one of the three presumptive codes (80305, 80306, 80307) may be billed per day.
  • Only one of the four definitive codes (G0480, G0481, G0482, G0483) may be billed per day.
  • Only one service unit per procedure code per date of service may be billed when submitting (80305-80307, G0480-G0483, G0659).
  • Drug confirmation tests are no longer eligible to be separately reported under any procedure code, unlisted or otherwise. This service is considered included in the presumptive or definitive drug testing procedure codes (80305-80307, G0480-G0483, G0659).
  • Specimen validity testing is not eligible to be separately billed under any procedure code. The code description for (80305-80307, G0480-G0483, G0659) indicates that this testing is included if it was performed.

BMS policy requires a prior authorization for drug screenings performed for over the limit of 24 per calendar year. The HF modifier must continue to be included on all claims for these codes when related to substance abuse treatment (e.g. Suboxone).

The presentation on the 2017 Drug Testing Changes can be found here: 2017 Drug Codes Changes Webinar Presentation

New** The West Virginia Bureau for Medical Services would like to include lab providers and other affected provider stakeholders in the discussion of an upcoming change to our drug screening policy. This process will provide us with a peer review of the proposed policy prior to the official 30-day public comment period. A draft of the proposed policy is attached for review and comment.

Please feel free to forward this e-mail to other stakeholders who may wish to comment. Please submit all comments to wvmedicalservices@kepro.com by March 31, 2018 and these will be forwarded to the Bureau of Medical Services. We look forward to your input.

Durable Medical Equipment (DME) Providers: KEPRO will accept requests for Nebulizers for children under the age of 3 via phone review. According to BMS policy, prior authorization is required and will offer the phone review option only with requests for nebulizers for children under age 3. Please call 1-800-346-8272 to initiate a C3 authorization or with any questions or issues regarding these requests.

Outpatient Surgery Services: For all outpatient procedures, where an assistant surgeon is indicated, please be sure to indicate this in your request. If not, a modification will need to be done, prior to billing, as the claim will not pay. For billing purposes, you will need to bill with the appropriate modifier as well. For outpatient procedures, where a co-surgeon is indicated, both surgeons will need an authorization. Please note Medicaid follows Medicare guidelines for determination in appropriateness for an assistant surgeon.

New** The West Virginia Department of Health and Human resources (DHHR) and Bureau of Medical Services (BMS) is pleased to announce the statewide expansion of the first West Virginia Health Homes Program serving members with bipolar disorder with at risk for Hepatitis B and/or C. This expansion, Health Homes 2, will begin April 2017.

New** Beginning April 2017, a new program, Health Homes Program 3, will be implemented to serve members with pre-diabetes, diabetes, or obesity, and at risk for anxiety and/or depression. This program will be piloted in the following 14 counties: Boone, Cabell, Fayette, Kanawha, Lincoln, Logan, Mason, McDowell, Mercer, Mingo, Putnam, Raleigh, Wayne and Wyoming.

 

New** Genetics-CFTR 2017 Announcement

Effective January 1, 2018 CPT codes 81220-81223 will require prior authorization for WV Medicaid Members. The provider must establish medical necessity by meeting the review criteria set by BMS to receive approval for these codes.

  • 81220 - CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; common variants (e.g., ACMG/ACOG guidelines)
  • 81221 - CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; known familial variants
  • 81222 - CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; duplication/deletion variants
  • 81223 - CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; full gene sequence

WV Medicaid will not be approving requests for 81220 for cystic fibrosis screening in the general population.  However, this code maybe considered medically necessary as a diagnostic test following abnormal newborn screening or in children with clinical features suggestive of cystic fibrosis.

Providers must seek prior authorization through KEPRO’s C3 Provider Portal. If you currently do not have access to the web-based portal, please contact KEPRO at http://wvaso.kepro.com or 1-800-346-8272 for registration information, or register via the online portal at https://c3wv.kepro.com.

WV Medicaid considers a core panel of 25 mutations that are recommended by the American College of Medical Genetics (ACMG) medically necessary for cystic fibrosis genetic testing.  WV Medicaid considers screening for cystic fibrosis mutations that extend beyond the standard mutation panel recommended by the ACMG to be experimental and investigational.

 

New** Webinar Announcement

We at KEPRO would like to invite you to participate in our upcoming webinar for Physical/Occupational Therapy. We will be conducting 2 webinars in total. There are some highlighted points we will be covering, as well as some provider education. If you absolutely cannot attend, we will be uploading the power point being presented to this website. Please send an e-mail to Sierra.Hall@kepro.com with the date and time you wish to attend.

PT/OT Webinars

Wednesday February 21, 2018 @ 10:00 am EST

Friday February 23, 2018 @ 2:00 pm EST

New**  Coverage Update

Effective 1-1-2016,  West Virginia Medicaid began coverage of Low Dose Computed Tomography (LDCT)  scans for lung cancer screening for members 55 and over, utilizing the following codes: 

  • G0296 - Counseling visit to discuss need for lung cancer screening. This code does not require prior authorization and has a one per rolling year limit.
  • G0297 - Low dose CT scan (LDCT) for lung cancer screening. This code requires prior authorization for medical necessity using InterQual Criteria that is based on U.S. Preventative Task Force (USPTF) guidelines.

Providers must seek prior authorization through KEPRO’s C3 Provider Portal. If you currently do not have access to the web-based portal, please contact KEPRO at http://wvaso.kepro.com or 1-800-346-8272 for registration information, or register via the online portal at https://c3wv.kepro.com.

New******Substance Use Disorder (SUD) Trainings

The Bureau for Medical Services is pleased to announce upcoming SUD trainings to be held in conjunction with the Spring Molina Provider Workshops. The SUD training will address components of the WV Medicaid SUD Waiver Manual including information on ASAM and residential levels of care. The SUD trainings will occur following the morning Molina Workshops. If you intend to participate in both trainings, please make sure you register for each one individually.

Complete the attached registration form and indicate which SUD training session you will attend, along with the number of attendees from your organization.  Forms should be returned to the contact information located on the bottom of the page. Registration must be received by April 9, 2018.

SUD Registration Form

You may review Chapter 504 - Substance Use Disorder Manual at this web address: http://dhhr.wv.gov/bms/Pages/Chapter-504-Substance-Use-Disorder-Services.aspx

For more information on the morning Spring Molina Provider Workshop, please visit the Molina Website at https://www.wvmmis.com or email the Molina Provider Field Representatives at WVProviderFieldRepresentative@molinahealthcare.com

2018 Spring Provider Workshop Registration link: 

https://www.surveymonkey.com/r/2018SpringProviderWorkshops

 

New Webinars Announcement - Drug Screening

Good Morning,

KEPRO would like to invite you to participate in our upcoming webinar for the new drug screening code changes effective July 1, 2018. We will be conducting 2 webinars-dates and times are listed below. We will be providing an overview of the policy and changes as well as providing detail on the process for requesting medical necessity authorization to exceed code limits. Please e-mail the completed registration form (attached) to wvmedicalservices@kepro.com with the date and time you wish to attend.  After the registration form is received, you will be sent a confirmation e-mail with the webinar information included.

Webinar Dates and Times:

Tuesday July 24, 2018 @ 9:00-11:00 am EST

Friday July 27, 2018 @ 1:00-3:00 pm EST

If you cannot attend one of the scheduled webinars, we will be uploading the PowerPoint being presented to the KEPRO website at http://wvaso.kepro.com.

Drug Screening Chapter 529.2 Comment Final

Drug Screening 2018 Codes Final

Drug Screening Policy Final

Drug Code Screen Webinar Registration Form

 

Newly Released Documents

BMS SUD Waiver Adult Residential Treatment Services Rates Memorandum

DHHR Press Release 2018-6-28 Second Phase of SUD Services Implemented

Instructions for enrolling in Public LMS Course DHHR

Peer Recovery Support Webinar Memorandum 7.11.18

 

***New Announcement - Molina Workshops

Please join us at the 2018 Fall Provider Workshops so that you and your staff will be aware of upcoming developments which may impact your practice/organization. Eight Workshops consisting of two separate sessions throughout the state from September 10th - 20th, 2018. Identical workshops are offered at each location to accommodate as many providers as possible.

Molina Morning Sessions:

Includes presentations by BMS, WVCHIP, KEPRO, Molina, the Medicaid Managed Care Organizations, and other Medicaid contractors. Topics include: New covered services, Pharmacy updates, and WVCHIP medical fluoride varnish policy.

Registration begins at 8:00 a.m.

Workshop is 9:00 a.m. to 12:00 p.m.

A light breakfast will be provided.

SUD Waiver Afternoon Sessions:

Includes presentations by BMS, KEPRO, and Molina and will provide updates on the Medicaid Substance Use Disorder Waiver. Topics include: Overview, implementation status, and next steps.

Registration begins at 1:00 p.m.

Workshop is 1:30 p.m. to 4:30 p.m.

A light snack will be provided.

 

*CEU’s may be available for hours attended*

Registration Link: https://www.surveymonkey.com/r/2018FallProviderWorkshop

 

 

Announcement re: Constitutional Amendment 1- on behalf of the West Virginia Bureau for Medical Services (BMS)

Below please find Public Notice information related to recently passed West Virginia Constitutional Amendment 1. The link for further information is: https://dhhr.wv.gov/bms/Public%20Notices/Pages/Public%20Notice%20regarding%20West%20Virginia%20Constitutional%20Amendment%201%20is%20now%20available.aspx

Also attached is the new certification form for your reference and use.

BMS Physician Certification for Pregnancy Termination Form

 

Public Notice regarding West Virginia Constitutional Amendment 1 is now available.

PUBLIC NOTICE

WEST VIRGINIA MEDICAID PROGRAM

REGARDING: WEST VIRGINIA CONSTITUTIONAL AMENDMENT 1

INITIALLY ISSUED: NOVEMBER 9, 2018

AMENDED: NOVEMBER 13, 2018

On November 6, 2018 West Virginia voters ratified West Virginia Constitutional Amendment 1, which states: “Nothing in this Constitution secures or protects a right to abortion or requires funding of abortion.” This amendment in turn abrogated the holding by the West Virginia Supreme Court in Women’s Health Center of West Virginia, Inc. v.Panepinto (1993) that West Virginia Code §9-2-11, which limits Medicaid funds paying for pregnancy terminations to several limited circumstances, is unconstitutional.

As a result of the ratification of this Constitutional Amendment as described above, effective November 6, 2018 at 7:30 PM, the West Virginia Bureau for Medical Services will only reimburse providers for pregnancy terminations in the following three circumstances, consistent with W. Va. Code §9-2-11:

 

  • If, on the basis of the physician’s best clinical judgment, there is a medical emergency that so complicates a pregnancy as to necessitate an immediate abortion to avert the death of the mother or for which a delay will create grave peril of irreversible loss of major bodily function or an equivalent injury to the mother: Provided, That an independent physician concurs with the physician’s clinical judgment;

 

  • If, on the basis of the physician’s best clinical judgment, there is clear clinical medical evidence that the fetus has severe congenital defects or terminal disease or is not expected to be delivered; or

 

  • If the individual is a victim of incest or the individual is a victim of rape when the rape is reported to a law-enforcement agency.

 

If there are any questions, please contact the West Virginia Bureau for Medical Services at (304) 558-1700.