Virginia Medicaid Bundle

VIRGINIA MEDICAID HOME CARE APPLICATION, POLICIES & MCO CONTRACTING ACCELERATOR

Eight-Week Coaching and Mentorship Program

Build a compliant Virginia home care agency, prepare your Medicaid provider enrollment application and pursue contracts with Virginia’s Cardinal Care managed-care organizations.

This eight-week coaching program gives Virginia home care agency owners step-by-step guidance through:

• Virginia Department of Health home care licensure compliance
• Virginia Medicaid provider enrollment
• PRSS and MES portal navigation
• CCC Plus Waiver provider requirements
• Agency-directed personal care and respite services
• Policies and procedures
• Cardinal Care MCO credentialing and contracting
• Electronic Visit Verification
• Service authorization and billing readiness
• Referral development and client acquisition

PROGRAM TUITION

Standard Coaching Program: $3,500

Payment Plan:

• Four payments of $950
• Total payment-plan price: $3,800

VIP Done-With-You Program: $5,500

The VIP program includes individual application-document reviews, policy customization support, two private strategy sessions and review of up to five MCO contracting packets.

VIRGINIA PROGRAMS COVERED

This course focuses primarily on:

• Agency-directed personal care
• Agency-directed respite care
• CCC Plus Waiver services
• Virginia Cardinal Care managed care
• Medicaid home and community-based services
• Skilled home health or private-duty nursing readiness, when applicable

Consumer-directed services facilitation, DD Waiver services, Medicare certification and private-duty nursing have different participation requirements. These subjects may require separate provider enrollments or specialized training.

WEEK 1 — VIRGINIA HOME CARE AND MEDICAID READINESS

• Virginia Home Care Organization classifications
• Home health services versus personal care services
• Skilled versus non-skilled home care
• Agency-directed versus consumer-directed services
• Virginia Department of Health’s role
• DMAS and Virginia Medicaid’s role
• CCC Plus Waiver overview
• Cardinal Care managed care overview
• Medicaid enrollment versus MCO contracting
• Determining which services your agency qualifies to provide
• Completing an agency readiness and gap assessment

Homework: Complete the Virginia Medicaid Readiness Assessment.

WEEK 2 — VIRGINIA LICENSING AND ORGANIZATIONAL COMPLIANCE

• Virginia Home Care Organization license review
• Virginia Code §32.1-162.7 and related home care laws
• 12VAC5-381 Home Care Organization regulations
• Governing-body responsibilities
• Administrator and nursing-supervisor requirements
• Liability insurance and fidelity-bond requirements
• Business-name, EIN and ownership consistency
• Organizational Type 2 NPI
• Taxonomy selection
• Service location and office readiness
• Criminal-background and barrier-crime requirements
• Employee and contractor qualification standards
• Drug-free workplace policies
• Preparing for VDH inspections and home visits

Homework: Assemble the agency’s licensing and organizational compliance folder.

WEEK 3 — VIRGINIA MEDICAID PRSS/MES ENROLLMENT

• Creating access to the Medicaid Enterprise System
• Navigating the PRSS Provider Portal
• Selecting the appropriate provider type and specialty
• New enrollment, revalidation and maintenance requests
• Legal name, ownership and controlling-interest disclosures
• Service location and pay-to information
• License, insurance and accreditation documentation
• Managing-employee disclosures
• Federal and state exclusion screening
• Electronic funds transfer documentation
• Provider participation agreements
• Tracking an application
• Responding to deficiencies
• Adding specialties after enrollment
• Updating licenses and demographic information
• Avoiding application inconsistencies

Homework: Complete the Virginia Medicaid Application Preparation Checklist.

WEEK 4 — CCC PLUS WAIVER PROVIDER REQUIREMENTS

• CCC Plus Waiver eligibility and LTSS screening
• Agency-directed personal care
• Agency-directed respite care
• Separate provider agreements and provider IDs
• Registered nurse qualifications
• Personal care aide qualifications
• Employee orientation and annual training
• RN supervision requirements
• Initial assessments and plans of care
• DMAS-required forms
• Scheduled services not provided
• Changes in condition
• Service limitations and authorization requirements
• Legally responsible individuals
• Nurse-delegated tasks
• Personal care versus skilled services
• Member freedom of choice
• Preventing institutional placement through home-based services

Homework: Complete the CCC Plus Provider Participation Audit.

WEEK 5 — VIRGINIA POLICIES AND PROCEDURES

Participants receive an editable Virginia-focused policy-and-procedure framework addressing:

• Governing-body responsibilities
• Management and administration
• Admission and eligibility
• Informed-consent agreements
• Client rights and responsibilities
• Nondiscrimination and accessibility
• Complaints and grievances
• Abuse, neglect and exploitation reporting
• Patient assessment and reassessment
• Plans of care
• Personal care services
• Respite services
• Skilled services, when applicable
• Medication assistance
• Nurse delegation
• RN supervision
• Employee qualifications
• Background checks and barrier crimes
• Personnel records
• Orientation and annual training
• Competency evaluations
• Employee and contractor supervision
• Infection prevention and control
• Emergency preparedness
• Continuity of operations
• Incident reporting
• Clinical and service records
• Record retention and confidentiality
• HIPAA privacy and security
• Quality improvement
• Utilization review
• Medicaid eligibility verification
• Service authorization
• Electronic Visit Verification
• Billing and claims integrity
• Overpayments and refunds
• Fraud, waste and abuse
• Federal and state exclusion screening
• Marketing and prohibited inducements
• Discharge and transfer
• Business closure and client transition

Homework: Customize the required policies for the agency’s approved services and staffing structure.

WEEK 6 — DOCUMENTATION, EVV AND BILLING READINESS

• Verifying Medicaid and MCO eligibility
• Confirming authorization before starting care
• Understanding authorized hours and service dates
• Electronic Visit Verification requirements
• Correcting EVV exceptions
• Personal care aide records
• RN supervisory notes
• DMAS-99 and related service documentation
• Plan-of-care updates
• Missed and refused visits
• Changes in member condition
• Incident documentation
• Service notes and time records
• Avoiding overlapping and duplicate services
• Procedure codes, units and modifiers
• Clean-claim preparation
• Timely filing
• Claims reconsiderations and appeals
• Overpayments and recoupments
• Preparing for DMAS and MCO quality-management reviews

Homework: Complete a mock member-record and claims audit.

WEEK 7 — CARDINAL CARE MCO CONTRACTING

Participants will learn how to pursue contracts with:

• Aetna Better Health of Virginia
• Anthem HealthKeepers Plus
• Humana Healthy Horizons of Virginia
• Sentara Health Plans
• UnitedHealthcare Community Plan

Training includes:

• State enrollment before MCO participation
• Provider-interest and network-participation forms
• Credentialing versus contracting
• Preparing the MCO contracting packet
• Agency roster and service-location records
• Ownership and credentialing disclosures
• Building a home care capability statement
• Writing a network-participation request
• Presenting service capacity and geographic coverage
• Responding to a closed network
• Credentialing follow-up schedules
• Tracking submissions and outstanding documents
• Verifying participating-provider status in PRSS
• Reviewing fee schedules and reimbursement terms
• Authorization and notification requirements
• Provider-directory verification
• Contract implementation after approval

Homework: Prepare contracting packets for all five Cardinal Care plans.

WEEK 8 — REFERRALS, CENSUS DEVELOPMENT AND 90-DAY PLAN

• Introducing the agency to MCO care coordinators
• Building relationships with hospitals and rehabilitation centers
• Working with LTSS screening teams
• Connecting with Area Agencies on Aging
• Discharge planner and social worker outreach
• Nursing facility transition opportunities
• Physician and healthcare-provider relationships
• Veteran and disability referral partners
• Community outreach compliance
• Preparing a referral packet
• Responding to referrals professionally
• Tracking inquiries, authorizations, admissions and starts of care
• Developing a staffing pipeline before accepting cases
• Creating a 30-, 60- and 90-day contracting and census plan

Homework: Complete the Virginia 90-Day Medicaid Contracting and Referral Plan.

WHAT IS INCLUDED

• Eight weekly live coaching sessions
• One private strategy session
• Session recordings
• Virginia Medicaid readiness assessment
• PRSS/MES application checklist
• CCC Plus provider participation checklist
• Virginia policy-and-procedure framework
• Policy customization guide
• Personnel-file checklist
• Member-record checklist
• RN supervision checklist
• EVV compliance checklist
• Quality-management review tool
• MCO contracting tracker
• Five-plan credentialing checklist
• Contracting emails and follow-up scripts
• Closed-network reconsideration template
• Capability-statement template
• Referral packet outline
• 90-day implementation plan
• Mentorship and accountability during the program

VIP DONE-WITH-YOU PACKAGE

The $5,500 VIP package includes:

• Everything in the standard program
• Two additional private coaching sessions
• Individual PRSS application document review
• Review of the agency’s customized policies
• Review of up to five MCO contracting packets
• Personalized deficiency and corrective-action checklist
• Customized capability statement
• Customized 90-day contracting and referral plan

WHO SHOULD ENROLL

• Virginia home care agency owners
• VDH-licensed Home Care Organizations
• License-pending agencies preparing for Medicaid
• Private-pay agencies adding Medicaid
• Agencies pursuing CCC Plus personal care cases
• Providers struggling with PRSS enrollment
• Enrolled providers that have not secured MCO contracts
• Agencies preparing for an MCO quality-management review

IMPORTANT DISCLAIMER

This course provides education, coaching, templates and organizational support. It does not provide legal advice, guarantee compliance or represent participants before VDH, DMAS, Medicare or any managed-care organization.

Completing this program does not guarantee Home Care Organization licensure, Virginia Medicaid enrollment, MCO credentialing, network participation, reimbursement rates, referrals or clients.

Participants must maintain an appropriate Virginia license or recognized accreditation for the services they intend to provide. Each MCO makes its own contracting and network-participation decisions.

All templates must be customized to the agency’s services, license, staffing structure and payer contracts. Participants should obtain review from a qualified Virginia healthcare attorney or compliance professional when necessary.

ENROLL TODAY

Stop allowing confusing Medicaid requirements, incomplete documentation and unanswered contracting requests to delay your agency.

Join Coach Brown for eight weeks of coaching, accountability and step-by-step guidance. Build your compliance foundation, prepare your Virginia Medicaid enrollment and pursue contracts with all five Cardinal Care health plans.

Click “Enroll Now” to begin.