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You’re invited to the 2nd Quarter Kaiser Permanente Virginia Medicaid Provider Virtual Townhall – June 25, 2024
Join us virtually on Tuesday, June 25, 2024, from 11 a.m. – 12 p.m. for our quarterly forum just for VA Medicaid providers.
Topics include:
- Kaiser Permanente news
- Optima Health rebranding to Sentara Health
- Pharmacy weight management service referrals
- Behavioral health referrals
- Virginia Medicaid rate increases
- Appointment wait time standards
- Updating your demographic information
- Online Affiliate features
- And more!
We look forward to seeing you!
Microsoft Teams meeting
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Meeting ID: 244 116 274 890
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Video Conference ID: 111 075 873 1
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+1 213-533-9530,,885875155# United States, Los Angeles
Phone Conference ID: 493 459 525#
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Virginia Medicaid Rate Increases
Effective January 1, 2024, the Department of Medical Assistance Services (DMAS) increased rates for a wide range of Virginia Medicaid services including the following:
- Early Intervention Services Increase: An increase of 12.5% was made to early intervention services. This increase aligns with the 12.5% already effective for other case management services. The full list of rate increases can be found at the following link: https://vamedicaid.dmas.virginia.gov/bulletin/early-intervention-rate-update-effective-january-1-2024.
- Mental Health Partial Hospitalization and Intensive Outpatient Increases: The mental health partial hospitalization per diem was increased from $250.62 to $500.00 and the intensive outpatient per diem was increased from $159.20 to $250.00. Procedure codes H0035 and S9480 were subject to these adjustments. The full list of rate increases can be found at the following link: https://vamedicaid.dmas.virginia.gov/bulletin/behavioral-health-service-rate-updates-effective-january-1-2024.
- Community-Based Behavioral Health Services Increase: A 10% increase was effective for community-based behavioral health services. The full list of rate increases can be found at the following link: https://vamedicaid.dmas.virginia.gov/bulletin/behavioral-health-service-rate-updates-effective-january-1-2024.
- Personal Care Services Increase: An increase of 5% was made to reimbursement for personal care and respite care services. This adjustment impacted services provided under the Child EPSDT COS. The full list of rate increases can be found at the following link: https://vamedicaid.dmas.virginia.gov/bulletin/personal-care-rate-update-effective-january-1-2024.
More information, including memos and bulletins about these rate increases can be found on the DMAS provider portal at https://vamedicaid.dmas.virginia.gov/provider.
New Online Affiliate Features: Pharmacy Weight Management Service Referrals & Radiology and Lab Order Entry
Kaiser Permanente’s Online Affiliate offers a wealth of time-saving tools. Through this convenient online portal, providers can view eligibility and benefits, submit claims and appeals, as well as much more. Below you’ll find details about two recently added features to the platform.
Pharmacy Weight Management Service Referrals
Effective February 6, 2024, Kaiser Permanente’s Online Affiliate platform offers providers an electronic method to refer patients to KPMAS Pharmacy Weight Management Service. This service will ensure appropriate and safe prescribing of injectable weight loss medication therapy (e.g. GLP-1 RAs), and help our patients fill their prescriptions seamlessly.
Note: This referral is only for evaluation of appropriateness of injectable weight loss medications for adults ages 18 or older; it is NOT for diabetes management. Some GLP-1 RAs medications may have utilization criteria; please review the utilization criteria prior to placing the referral.
Before prescribing an injectable weight loss medication, providers should enter a referral into the Pharmacy Weight Management Service for evaluation of appropriateness of injectable weight loss medication.
If a patient meets the criteria, they will be enrolled into the service, and the clinical pharmacist will contact the provider for an injectable weight loss medication order. Patients who do not meet the criteria will not be enrolled, and alternative therapies will be recommended.
Please follow the instructions below to refer patients to KPMAS Pharmacy Weight Management Service:
- Sign into Online Affiliate: https://epiclink.kp.org/MAS/epiclink
- On the “Home” screen, select the “Order Entry” option from the drop-down menu under the “Patient” category.
- On the “Order Entry” screen, select your patient using the search function or the “My Patients” list, and then select the appropriate “Ordering Clinic” from the dropdown menu.
- On the following screen, in the “New Procedure” field, type “Ref Med Management.” Select “Clin Pharm Chart Review – Injectable Weight Loss Medication Review”
- Complete the referral form, making sure to fill out the required fields indicated by stop signs. Then click “Accept.”
- Click on the “Sign Orders” button on the following screen to submit the referral.
If you would like to request a call back or training regarding this referral process, please fill out the KPMAS Drug Use Management intake form.
Radiology and Lab Order Entry
In 2023, Online Affiliate rolled out a new feature for radiology and lab orders. Kaiser Permanente’s Online Affiliate platform now allows external providers to request radiology and lab order directly through the portal. Providers can select up to 16 laboratory options and over 50 radiology procedures via the order entry screens.
If you have questions about Online Affiliate, please email KP-MAS-OnlineAffiliate@kp.org.
Authorization-waived CPT Codes for Behavioral Health
To help meet the growing demand for mental health services, we have expanded the list of procedures that do not require pre-authorization. This is effective immediately, and we will update the list if any changes are made in the future.
Kaiser Permanente members may contact a Behavioral Health provider directly for an appointment. Pre-authorization is not required for the initial consultation and some routine care services. Please see below for the complete list of authorization-waived CPT codes and their corresponding descriptions.
| CPT Code | Description |
| H0014 | ALCOHOL AND/OR DRUG SERVICES; AMBULATORY DETOX |
| H0020 | ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMIN/SERVICE |
| G2067 | MEDICATION ASSISTED TREATMENT, METHADONE; WEEKLY |
| G2068 | MEDICATION ASSISTED TREATMENT, BUPRENORPHINE; WEEKLY |
| G2078 | TAKE HOME SUPPLY OF METHADONE; UP TO 7 ADD DAY SUPPLY |
| 90791 | PSYCHIATRIC DIAGNOSTIC EVALUATION |
| 90792 | PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES |
| 90832 | PSYCHOTHERAPY W/PATIENT 30 MINUTES |
| 90833 | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN |
| 90834 | PSYCHOTHERAPY W/PATIENT 45 MINUTES |
| 90836 | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN |
| 90837 | PSYCHOTHERAPY W/PATIENT 60 MINUTES |
| 90838 | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN |
| 90846 | FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS |
| 90847 | FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS |
| 90849 | MULTIPLE FAMILY GROUP PSYCHOTHERAPY |
| 90853 | GROUP PSYCHOTHERAPY |
| 96127 | BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT |
| 99202 | OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES |
| 99203 | OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES |
| 99204 | OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES |
| 99205 | OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES |
| 99211 | OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP |
| 99212 | OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN |
| 99213 | OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN |
| 99214 | OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN |
| 99215 | OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 |
| 99307 | SUBSEQUENT NURSING FACILITY CARE (10 MIN) |
| 99308 | SUBSEQUENT NURSING FACILITY CARE (15 MIN) |
| 99309 | SUBSEQUENT NURSING FACILITY CARE (25 MIN) |
| 99310 | SUBSEQUENT NURSING FACILITY CARE (35 MIN) |
Ending the COVID-19 Public Health Emergency
On May 11, 2023, the Federal Government will end the public health emergency (PHE). This action marks a significant milestone as we enter the endemic phase of COVID-19.
This will affect how COVID-19 vaccines, testing, and treatment are provided and covered. In most instances, these services will return to being covered like any other condition alongside applicable plan out-of-pocket costs. The pertinent changes are outlined below:
| Commercial Plans | In network: COVID-19 vaccines will continue to be covered under preventive benefits at applicable plan cost sharing, typically $0. Out-of-network: COVID-19 vaccinations will no longer be covered. |
| Medicare Plans | In network: COVID-19 vaccines will continue to be covered by Medicare part B at no cost. Out-of-network: COVID-19 vaccinations will no longer be covered. |
| Medicaid Plans | COVID-19 vaccines will continue to be covered at no cost through September 2024. |
| Commercial Plans | COVID-19 home antigen tests coverage expires and will no longer be covered. |
| Medicare Plans | COVID-19 home antigen tests coverage expires and will no longer be covered, per federal guidance. |
| Medicaid Plans | COVID-19 home antigen tests will continue to be covered at no cost through September 2024. |
| Commercial Plans | In-network: COVID-19 diagnostic PCR testing will be covered under the outpatient diagnostic lab benefit at applicable plan cost-sharing. Testing for other purposes, such as for work, school, or travel is not covered. Out-of-network: COVID-19 PCR testing will only be covered for urgent care and emergency services, when legally required, or when OON coverage is included in a Kaiser Permanente member’s plan. |
| Medicare Plans | In-network: COVID-19 diagnostic PCR testing will be covered under the outpatient diagnostic lab benefit at applicable plan cost-sharing. Testing for other purposes, such as for work, school, or travel is not covered. Out-of-network: COVID-19 PCR testing will only be covered for urgent care and emergency services when legally required or when OON coverage is included in a Kaiser Permanente member’s plan. |
| Medicaid Plans | COVID-19 PCR tests will continue to be covered at no cost through September 2024, in compliance with federal guidance. |
| Commercial Plans | In-network: COVID-19 treatment will be covered under the drug benefit with applicable plan cost-sharing. Out-of-network: COVID-19 treatment will only be covered for urgent care and emergency services, when legally required, or when OON coverage is included in a Kaiser Permanente member’s plan. |
| Medicare Plans | In-network: COVID-19 treatment will be covered under the Medicare Part B drug benefit with applicable plan cost-sharing. Out-of-network: Coverage for COVID-19 treatment from an out-of-network provider expires and will no longer be covered, per federal guidance. |
| Medicaid Plans | COVID-19 treatment will continue to be covered at no cost through September 2024, in compliance with federal guidance. |
Thank you for partnering with Kaiser Permanente to provide quality health care services to our members throughout every stage of the COVID-19 pandemic.
COVID-19
We are working to address questions and concerns you have. Please see the below FAQs and reference guide to assist you with providing critical care to our members. We will continue to keep you informed as the situation evolves.
COVID-19 Claims Processing FAQ for KPIC Providers - updated 5/11/2023
COVID-19 Claims Processing FAQ for Providers – updated 5/9/2023
COVID-19 KPIC Claims FAQ– updated 5/5/2021
COVID-19 Coding Quick Reference Guide – updated 1/22/2021
Telehealth Talking Points
Telehealth Guide – updated 3/10/2022
Medicare Telehealth FAQ
COVID-19 Vaccine FAQ – updated 5/9/2023
COVID-19 KPIC Vaccine FAQ – updated 5/5/2021
MDH COVID-19 #1
MDH COVID-19 #12 Temporary Registration of RBT – expired August 15, 2021
DC Health Vaccine Counseling
Determining the Jurisdiction of a Plan
All of our medical plans are located in Maryland, Virginia, or the District of Columbia or is a Federal plan. Each jurisdiction has unique guidelines for billing claims such as member balance billing. Be sure to know the member’s plan situs to ensure appropriate claim processing.
Finding the situs of a member’s plan is simple. Locate the member’s plan name when verifying the member benefits in Kaiser Permanente Online Affiliate. The plan name is under Coverages & Benefits. The Payor/Plan name will contain one of the following as part of the plan name:
- Maryland or MD
- Virginia or VA
- District of Columbia or DC
- Federal or FD (Maryland guidelines apply to Federal plans)
Some examples of what you will see online are:
- Payor/Plan
- MAS KP-MEDICAID MCO MARYLAND / MD MEDICAID PLAN (20325) 0718
- MAS KP-MID ATLANTIC / VA KPIF ON HCR HMO SILVER $15/$40 (3787
If you are uncertain about the situs of a member’s plan, please contact our Member Services Call Center at 1-800-777-7902.
If you are not registered for access to Kaiser Permanente Online Affiliate, you may register online at www.kp.org/providers/mas.
New Provider Email Contacts at KP
Effective January 1, 2020, we’re making some updates to where information should be sent to us so that we can serve you better and ensure that inquiries are going directly to those that will handle them.
Ensuring that your message is sent to the correct email address or that your call is placed to the correct phone number allows us to respond quickly and serve you better.
The below list provides updated contacts at Kaiser Permanente for participating network providers.
You may begin to use the new contacts on January 1, 2020. If you’re unsure about who to contact for an issue, contact Provider Relations at provider.relations@kp.org or 877-806-7470 for assistance.
| Provider Experience Email: provider.relations@kp.org Phone: 877-806-7470 |
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Member Services Phone: |
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| Provider Demographic Updates Email: provider.demographics@kp.org |
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| Utilization Management Phone: 800-810-4766 |
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| Interested Providers Email: interested.providers@kp.org |
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| Provider Recredentialing Email: ppqa-mas@kp.org |
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Diversity
Members have the right to free language services for health care needs. We provide free language services including:
- 24-hour access to an interpreter: When members call to make an appointment or talk to their personal physician, if needed, we will connect them to a telephonic interpreter.
- Translation services: Some member materials are available in the member’s preferred language.
- Bilingual physicians and staff: In some medical centers and facilities, we have bilingual physicians and staff to assist members with their health care needs. They can call Member Services or search online in the medical staff directory at kaiserpermanente.org.Braille or large print:
- Blind or vision impaired members can request for documents in Braille or large print or in audio format.
- Telecommunications Relay Service (TRS): If members are deaf, hard of hearing, or speech impaired, we have the Telecommunications Relay Service (TRS) access numbers that they can use to make an appointment or talk with an advice nurse or member services representative or with you.
- Sign language interpreter services: These services are available for appointments. In general, advance notice of two or three business days is required to arrange for a sign language interpreter; availability cannot be guaranteed without sufficient notice.
- Educational materials: Health education materials can be made available in languages other than English by request. To access Spanish language information and many educational resources go to kp.org/espanol or kp.org to access La Guía en Español (the Guide in Spanish). Members can also look for the ñ symbol on the English language Web page. The ñ points to relevant Spanish content available in La Guía en Español.
- Prescription labels: Upon request, the KPMAS pharmacist can provide prescription labels in Spanish for most medications filled at the Kaiser Permanente Pharmacy.
At Kaiser Permanente, we are committed to providing quality health care to our members regardless of their race, ethnic background or language preference. Efforts are being made to collect race, ethnicity and language data through our electronic medical record system, HealthConnect®. We believe that by understanding our members’ cultural and language preferences, we can more easily customize our care delivery and Health Plan services to meet our members’ specific needs.
Currently, when visiting a medical center, members should be asked for their demographic information. It is entirely the member’s choice whether to provide us with demographic information. The information is confidential and will be used only to improve the quality of care. The information will also enable us to respond to required reporting regulations that ensure nondiscrimination in the delivery of health care.
We are seeking support from our practitioners and providers to assist us with the member demographic data collection initiative. We would appreciate your support with the data collection by asking that you and your staff check the member’s medical record to ensure the member demographic data is being captured. If the data is not captured, please take the time to collect this data from the member. The amount of time needed to collect this data is minimal and only needs to be collected once. Recommendation for best practices for collecting data is during the rooming procedure.
In conclusion, research has shown that medical treatment is more effective when the patient’s race, ethnicity and primary language are considered.
To access organization wide population data on language and race, please see our Diversity & Inclusion Annual Report*.
To obtain your practice level data on language and race, please email the Provider Relations Department at Provider.Relations@kp.org.
Provider Referral Requests
The Kaiser Permanente Utilization Management Operations Center reviews each referral request and determines the number of visits that are medically necessary. When requesting referrals, please only request one visit or the exact number of visits that will be needed for a three (3) month period.
Additional visits can be added if medically necessary before approval but if more visits are requested than needed the member will receive a partial approval/denial letter which has been creating confusion for members as they believe their referral is being denied. To help avoid this, please only request one visit or the exact number of visits necessary.