1. KEPRO Service Authorization Process Waiver Services: Technology Assisted Wavier INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT

2. Please note that for Technology Assisted Wavier, all requests must be submitted via KEPRO’s Atrezzo Connect System effective 9/1/2015. Reference the DMAS Medicaid Memo dated 6/15/2015, “Notification that KEPRO is Converting to Electronic Process for Submitting Service Authorization Requests – Effective September 1, 2015”. To access Atrezzo Connect on KEPRO’s website, go to http://dmas.KEPRO.com.http://dmas.KEPRO.com Provider registration is required to use Atrezzo Connect. The registration process for providers happens immediately on-line From http://dmas.KEPRO.com, providers not already registered with Atrezzo Connect may click on “Register” to be prompted through the registration process. Newly registering providers will need their 10-digit National Provider Identification (NPI) number and their most recent remittance advice date for YTD 1099 amount.http://dmas.KEPRO.com If you are a new provider who has not received a remittance advice from DMAS, please contact KEPRO at 1-888-827-2884 or atrezzoissues@kepro.com to receive a registration code which will allow you to register for KEPRO’s Atrezzo Connect Portal. The Atrezzo Connect User Guide is available at http://dmas.KEPRO.com : Click on the Training tab, then the General tab.http://dmas.KEPRO.com Methods of Submission Service Authorization Requests to KEPRO

3. Providers with questions about KEPRO’s Atrezzo Connect Provider Portal may contact KEPRO by email at atrezzoissues@KEPRO.com. atrezzoissues@KEPRO.com For service authorization questions, providers may contact KEPRO at providerissues@KEPRO.com.providerissues@KEPRO.com KEPRO may also be reached by phone at 1-888-827- 2884, or via fax at 1-877-OKBYFAX or 1-877-652-9329. Service Authorization Requests: Contact Information for KEPRO/ DMAS Provider Information

4. DMAS publishes electronic and printable copies of its Provider Manuals and Medicaid Memoranda on the DMAS Web Portal at https://www.virginiamedicaid.dmas.virginia.gov/wps/portal. This link opens up a page that contains all of the various communications to providers, including Provider Manuals and Medicaid Memoranda. The Internet is the most efficient means to receive and review current provider information. If you would like a paper copy of a manual, you can order it by contacting: Commonwealth-Martin at 1-804-780-0076. A fee will be charged for the printing and mailing of the manual updates that are requested. Service Authorization Process

5. Service Authorization (Srv Auth) Submission Requirements for the following Waiver Service Type: Technology Assisted Wavier (TW) - 0960 Service Authorization Process

6. The Provider verifies eligibility by using the DMAS web based ARS system at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal or by calling: Medicall at 1-800-884-9730 or 1-800-772-9996.

7. Submitting Srv Auth Requests Requests should be submitted via:  Atrezzo Connect http://dmas.KEPRO.comhttp://dmas.KEPRO.com (registration required) For any questions regarding the submission of Srv Auth requests please contact KEPRO at 888-827-2884 or 804-622-8900.

8. Covered Services Under Technology Assisted Waiver (TW)- 0960 Environmental Modifications (S5165) and Environmental Modifications Maintenance (99199 U4) Assistive Technology (T1999) and Assistive Technology Maintenance (T1999 U5) All other services authorized by DMAS. The Srv Auth is end dated 30 days from the approved “date from” (Start of Care date) in the VAMMIS system.

9. Maximum Medicaid funded expenditure is $5,000.00 per calendar year for all Environmental Modifications (EM) and Assistive Technology (AT) codes combined (i.e. $5,000.00 for EM codes and $5,000.00 for AT codes). May have multiple items requested within the calendar year by the same or different provider but can not exceed $5,000.00. Cost cannot be carried over from one calendar year to another. Covered Services Under Technology Assisted Waiver (TW) - 0960 (cont’d)

10. Dates of Service authorized cannot cross over calendar years. This service does not include items covered in the State Plan for Medical Assistance as a Durable Medical Equipment and Supplies or through another program. Request may be submitted by DME providers, or Nursing Agencies (If by Nursing Agencies, a DME provider number is required). Covered Services Under Technology Assisted Waiver (TW) - 0960 (cont’d)

11. Environmental Modifications – S5165 and 99199 U4 Service is available to individuals who are enrolled in and receiving Technology Assisted Waiver services. Submitted documentation must include the description of the item, cost of materials, labor and must provide direct medical or remedial benefit to the individual.

12. Modification can not be duplicated. EM can not be authorized to bring substandard dwelling up to minimum habitation standards. EM must not increase square footage of residence. Environmental Modifications (EM) – S5165 and 99199 U4 (cont’d)

13. Assistive Technology (AT) - T1999 and T1999 U5 Service is available to individuals who are enrolled in and receiving Tech Waiver services. Assistive Technology must be portable.

14. May have multiple items requested within the calendar year by the same or different provider but can not exceed $5,000.00. Documentation must include the name and title of the qualified professional who recommended the AT via a therapeutic evaluation, to include a statement to the need and medical necessity for the purchase. Assistive Technology (AT) - T1999 and T1999 U5 (cont’d)

15. Dates of Service authorized cannot cross over calendar years. Items can not be duplicated or rented. Must be medically necessary, cost effective, and not for educational purposes only. Assistive Technology (AT) - T1999 and T1999 U5 (cont’d)

16. TW respite applies to agency directed skilled nursing respite care RN (S9125 TD) and agency directed skilled nursing respite care LPN (S9125 TE). The service authorization for this waiver is contingent upon the approval for Skilled Private Duty Nursing services by DMAS on the Srv Auth file in VaMMIS. The member must be enrolled in the TW on the LOC ‘A’ in the DMAS Srv Auth system before processing Respite service requests. Skilled Respite –S9125 (TD) S9215 (TE )

17. Service approval dates must fall between the dates of the LOC ‘A” segment. A Maximum of 360 hrs may be authorized per calendar year. There must be an unpaid primary caregiver. The provider can submit at anytime once the PDN authorization has been completed by DMAS TW staff. However, the provider must submit within 10 business days of start of care for respite services. Skilled Respite –S9125 (TD) S9215 (TE )

18. Submitting Additional Information If upon review of the documentation submitted for a Srv Auth request is determined to be insufficient to process the request, the Clinical Reviewer will “pend” the request for the additional information. To submit additional information on a pended case: Via Atrezzo Connect- Providers must submit additional information through Atrezzo Connect by choosing "add to comments” if documents is needed the provider will need to upload the documents to Atrezzo by using the “Upload Attachments” feature. (NOTE: The "extend case" feature is used when requesting additional days of coverage only). Whenever a provider adds to comments, this puts the case back in the nurse review queue.

19. Submitting Changes to an Existing Case (for all formats) If the request is for a discharge – please request under the existing case number to be discharged. You will need to enter a discharge note in the clinical note section of the case. Do not create a new case. If the request is for a change (increase or decrease) in dates, units, or hours, please request under the existing case number, do not open a new case for these types of requests. Requesting or creating new cases in place of updating existing cases only delays processing time and causes duplicate and overlapping date errors. There are no automatic renewals of service authorizations. Providers must submit requests for continuation of care needs, with supporting documentation, prior to the expiration of the current authorization.

20. Reference Materials Technology Assisted Waiver and Private Duty Nursing Services Manual Chapter IV and Appendix D Technology Assisted Waiver and Private Duty Nursing Services Manual Chapter IV Training Information, Srv Auth educational resources & DMAS Manuals at: http://dmas.KEPRO.com

21. General Information for All Service Authorization Submissions There are no automatic renewals of service authorizations. Providers must submit requests for continuation of care needs, by completing the questionnaire, prior to the expiration of the current authorization. Providers must verify member eligibility prior to submitting the request. Authorizations will not be granted for periods of member or provider ineligibility. Providers must submit a service authorization request under the appropriate service type. Service authorization requests cannot be bundled under one service type if the service types are different.

22. Virginia Medicaid Web Portal DMAS offers a web-based Internet option to access information regarding Medicaid or FAMIS member eligibility, claims status, check status, service limits, service authorizations, and electronic copies of remittance advices. Providers must register through the Virginia Medicaid Web Portal in order to access this information. The Virginia Medicaid Web Portal can be accessed by going to: www.virginiamedicaid.dmas.virginia.gov. www.virginiamedicaid.dmas.virginia.gov If you have any questions regarding the Virginia Medicaid Web Portal, please contact the Xerox State Healthcare Web Portal Support Helpdesk, toll free, at 1-866-352-0496 from 8:00 a.m. to 5:00 p.m. Monday through Friday, except holidays. The MediCall audio response system provides similar information and can be accessed by calling 1-800-884-9730 or 1-800-772-9996. Both options are available at no cost to the provider. Providers may also access service authorization information including status via KEPRO’s Provider Portal at http://dmas.KEPRO.com.http://dmas.KEPRO.com

23. Important Resources The “HELPLINE” is available to answer questions Monday through Friday from 8:00 a.m. to 5:00 p.m., except on holidays. The “HELPLINE” numbers are: 1-804-786-6273 Richmond area and out-of-state long distance 1-800-552-8627 All other areas (in-state, toll-free long distance) Please remember that the “HELPLINE” is for provider use only. Please have your Medicaid Provider Identification Number available when you call.

24. Thank you