The Virginia Department of Health (VDH), Division of Disease Prevention has administered Ryan White Part B funding for HIV care services to persons living with HIV/AIDS in Virginia since 1991. A major part of Part B funding is the Virginia Medication Assistance Program (VA MAP) that provides medications for low-income, uninsured individuals with HIV/AIDS. The remaining funds provide HIV care services, targeted to deliver medical care and support services to eligible individuals living with HIV/AIDS. Ryan White funding is the payer of last resort.
Policy Announcement
Effective May 06, 2022.
Virginia Ryan White Part B Unified Eligibility Policy & Procedures
The Virginia Ryan White HIV/AIDS Program Part B (RWHAP B) implemented Unified Eligibility (UE) that will have clients conduct eligibility every 24 months for all RWHAP B services, including ADAP services coordinated through VA MAP. This is a major policy and procedure shift for RWHAP B client eligibility as this removes the 6-month recertification requirement and changes client eligibility to a 24-month period. Clients and providers no longer have to do four eligibility assessments per year! Agencies not contracted with the Virginia RWHAP B program are not able to conduct these client assessments at this time, but can make referrals to the agencies that can.
Documents related to the UE policy and procedures are listed below.
- Full Unified Eligibility Policy and Procedures please click here.
- Updated Supportive Documentation for Unified Eligibility Checklist please click here.
- Updated Form for No-income Letter Documentation click here for English or click here for Spanish.
Policy Highlights
♦ This policy replaces any prior policies and guidance regarding Virginia’s RWHAP B and VA MAP client eligibility processes. For the Full Unified Eligibility Policy and Procedures, please click here.
♦ Virginia RWHAP B clients will need to verify their eligibility status every 24 months. The new process does not require 6-month recertifications. These changes align with the requirements and flexibilities in HRSA’s PCN #21-02.
♦ VDH requires RWHAP B-contracted agencies to conduct period checks called Client Access Reviews (CARs) for anything that potentially changes the client’s eligibility for services. Subrecipients will need to document CARs and upload any changes discovered that affect client eligibility into Provide® within 7 days.
♦ Virginia RWHAP B-contracted agencies will conduct all client eligibility assessments for all RWHAP B services, including ADAP. To access a list of these contracted agencies, please click here for the VDH Resource Connection website.
♦ Virginia RWHAP B-contracted agencies will use the state’s new client-level data system called Provide Enterprise®. These contracted agencies must create client records and upload supportive documentation that supports each eligibility criterion which remains the same for VA RWHAP B. At this time, if agencies are not a Virginia RWHAP B-contracted agency, then they will not have access to Virginia RWHAP B's Provide Enterprise® system. Virginia will explore this possibility with the system’s vendor for future integration. For information about the Virginia Provide Enterprise® system, please click here.
♦ Eligibility criteria includes: Proof for Virginia residency; Household income at or below 500% of FPL; Insurance coverage status for services requested to help ensure RWHAP is payer of last resort; and One-time proof of a diagnosis with HIV disease documented. See the new and updated Supportive Documentation for Unified Eligibility Checklist by clicking here.
♦ As of May 2022, VA MAP no longer processes eligibility assessments for medication access. Through UE, VA MAP will be reviewing eligibility assessments to determine the appropriate VA MAP service option for a client to access their medication. Eligibility for medication access will be determined through the eligibility assessments conducted by a Virginia RWHAP B-contracted agency. To access a list of these contracted agencies, please click here for the VDH Resource Connection website.
Virginia RWHAP B eligibility and non-RWHAP B agencies
Agencies not contracted with Virginia RWHAP B to provide services cannot conduct unified eligibility assessments at this time. If an agency provides services from other RWHAPs A, C, and/or D and does not contract with Virginia RWHAP B, then the agency must refer clients to these Virginia RWHAP B-contracted agencies to conduct eligibility assessments for any Part B services, including ADAP. Clients can also contact any of the contracted agencies of their choice to complete their eligibility assessment for Part B services. Anyone can access a list of these contracted agencies by clicking here for the VDH Resource Connection website.
Resources for Virginia Ryan White Service Providers
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- For Grant Year starting on April 1st:
- HCS Invoice Template: VA RWHAP B Invoice Template
- HCS Subrecipient Budget Template: Subrecipient VA RWHAP B Budget Workbook
- HCS Vendor Budget Template: Vendor VA RWHAP B Budget Workbook
- HCS Work Plan Template: Virginia Ryan White Part B Work Plan
- Subrecipient Annual Progress Report Template
- RWHAP B Subrecipient Quarterly Report Template
- For Grant Year starting on April 1st:
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- Ryan White Part B Service Standards
- FPL Income Requirements for Virginia Ryan White Part B
- VDH Ryan White Part B Service Unit Definitions
- Ryan White Part B Case Management Standards
- HRSA Ryan White Program Service Definition
- Outpatient Reimbursement for Ambulatory HIV Medical Care and Labs Policy
- HRSA/HAB Ryan White Part B Monitoring Standards (HRSA website)
INFRASTRUCTURE
Virginia Ryan White Part B Quality Management Plan
2025 | 2024 | CQM Plan Review Checklist Template | 2023 | 2022
Virginia Ryan White Part B Quality Management End of Year Report
Quality Management Advisory Committee (QMAC)
QMAC Orientation Manual | QMAC Workshop Slides
QMAC Newsletters
Peer Review Year End Final Report
PERFORMANCE MEASURES
Virginia Ryan White HIV/AIDS Cross Parts
Virginia HIV Care Continuum Data
July 2023 | July 2022 | August 2021 | February 2021
Virginia Ryan White Part B Statewide Quality Improvement Project (QIP)
RESOURCES
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- Center for Quality Improvement and Innovation (CQII)
- QMAC Quarterly Meeting Documents (Glasscubes login required)
VACAC - Virginia Quality of Care - Consumer Advisory Committee
Medicaid members and individuals applying for health coverage have a new and easy way to send documents and verify information needed to process applications or respond to other requests. Visit the CoverVA or Cubre Virginia websites to learn more about how to use the new email address, verify_docs@coverva.org. You can scan and upload, attach electronic copies, or take a picture of your information and send it using this convenient option. If additional information is needed, you will receive another letter by mail explaining next steps.
Please note that this email address is available only for sending information to Virginia Medicaid. Do not send questions to this address; you will not receive a response. If you have questions, please call the Cover Virginia call center at 1-855-242-8282.
This new email address was created to help individuals apply for Medicaid during the COVID-19 health emergency, but DMAS will continue to maintain it as a convenient service to our members and applicants.
Learn more by visiting the CoverVA website:
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- Application page: https://www.coverva.org/apply/
- Quarterly Contractors Meeting Dates: (Quarterly on the First Wednesday of the month)
March 12, 2025 ♦ June 4, 2025 ♦ September 3, 2025 ♦ December 3, 2025
- Quality Management Advisory Committee: (In-person as of GY 2024)
Mid-Atlantic Telehealth Resource Center (MATRC) (434) 906-4960
What is the Different Between Telemedicine, Telehealth and Remote Monitoring?
Telemedicine typically refers to the practice of medicine using technology to deliver care at a distance. A physician/clinician in one location uses a telecommunications infrastructure to deliver care to a patient at a distant site. Telemedicine is a subset of telehealth.
Telehealth refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services (for example, clinician to clinician consults, patient education services, interprofessional care teams, etc.)
Remote patient monitoring refers to using technology to gather patient data outside of traditional healthcare settings, for example, using digital scales, glucometers, pulse-ox, etc. to monitor a patient’s condition while they are at home.
I Don’t Know What I Don’t Know. Where Do I Start?
- Request Technical Assistance online using this form: Click Here
Do You Have Any Specific Resources for TeleMental/Behavioral Health Providers Who Are Getting Started?
- We have a great website called the Telebehavioral Health Center of Excellence with a large number of online resources just for you: Click Here.
- Make sure you take advantage of our Virtual Office Hours (see bullet three above).
- If you are serious about telemental/behavioral health, you can get yourself Board Certified as a Telemental Health Provider (9 modules, $50 per module): Click Here
Do You Have Any Specific Resources for Providers Interested in Getting Started with Remote Patient Monitoring?
- We have a great toolkit on our website dedicated to helping providers get started with Remote Patient Monitoring. Click Here. Make sure you download the actual RPM Toolkit (it’s an 8 page PDF document with lots of great information)
Do You Have Any Specific Resources Related to Telehealth Technology and HIPAA?
- If you have a budget for this sort of thing and the luxury of taking your time, we would recommend your using our Vendor Selection Toolkit: Click Here
- Since most of you are frantically trying to get started yesterday, if you don’t currently have any technology that you could use for a telehealth visit, please know that as part of its response to the pandemic, a change was made regarding HIPAA. The HHS Office for Civil Rights is exercising enforcement discretion and waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype: Click Here. With that said, please check your State policies, as not every state has waived their HIPAA requirements.
- Free access to Vivovitals remote patient monitoring platform for providers in the United StatesIf you don’t have a budget for telehealth technology, the following are vendors who are offering either free or significantly reduced prices as a response to COVID-19. Please note that MATRC is not in a position to either endorse or recommend any of the vendors on this list. We strongly encourage you to do your due diligence when making a vendor selection. There may be other vendors also making available platforms for free or at a significantly reduced price in response to COVID-19. These are the ones that have been brought to our attention thus far:
- Free white-labeled RingMD telemedicine platform for doctors, healthcare groups and other organizations negatively affected by the outbreak.
Do You Have Any Specific Resources on How to Provide a Telehealth Visit?
- Free Telehealth Etiquette Video Series: Click Here
- Free (registration required) Telehealth Coordinator Online Training: Click Here
- Depending on the type of provider you are and the type of service you offer, there are some specific clinical guidelines and best practices for telehealth that have been developed. There are too many documents to list here. Please contact us using our online Technical Assistance Form and let us know your specific interest area(s): Click Here
- If you are an FQHC, the Weitzman Institute is offering a series of Project ECHO sessions on Preparing for COVID-19. One of the sessions is entitled “Develop and Define Your Telehealth Strategy” Click Here for a listing of upcoming sessions and access to recordings of past sessions.
- If you are a physician, the AMA has developed a “Quick Guide to Telemedicine in Practice” that has a section on Practice Implementation: Click Here
How Do I Document a Telehealth Visit?
For documentation of a telehealth visit, you should include everything you usually need to document for the CPT or E&M code being billed, PLUS…
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- Patient’s location (enough detail to satisfy a Medicare audit, i.e., eligible facility in an eligible geographic location.
- With all the exceptions being made during this pandemic with the waiver, this is not as important during the state of emergency, but in general you should do this so you might as well make it a practice!
- If the patient’s home is the location of service, and the address is already somewhere in the medical record, then you just need to include in your note that the visit took place at the patient’s home. You do not need to capture the address again.
- It is always good practice to verify the patient’s location at the start of every virtual visit. Do not assume they are at home! Remember that if the patient experiences an emergency/crisis when they are in the middle of a visit with you, if you don’t have easy access to their physical location address (a PO Box will not work), it will be impossible to contact first responders and have them deployed to the patient’s location.
- Provider’s location (this would be the usual place of practice – for most, it would be the office location, but if home is a routine or the only office location, then the provider’s home location should be registered as a site of service and used)
- That the encounter was conducted via telehealth
- Start and stop time
- That the patient consented (unless otherwise documented). Please refer to your State’s laws/licensing board regulations and guidance documents regarding specific requirements. See section on consent above for how to do this.
- Any other providers involved, including tele-presenters
- Optional: A reason for using telehealth (medical or otherwise), and any criteria used to evaluate whether the case was appropriate for telehealth.
- Patient’s location (enough detail to satisfy a Medicare audit, i.e., eligible facility in an eligible geographic location.
TELEHEALTH POLICY AND COVID-19
For a summary of the most up to date information on changes at the federal level, Click Here!
TELEHEALTH REIMBURSEMENT AND COVID-19: BILLING, CODING AND DOCUMENTATION
How Do I Bill and Code for Telehealth Services?
Click Here to access a really good guidance document on billing and coding for telehealth. In general, you would use the same CPT or E&M codes as for an in-person encounter, but to indicate that the service was provided via telehealth, each payer type has their own schema pertaining to a specific modifier or POS code (sometimes even both) they want you to use. In addition, this guidance document also discusses how to bill and code for several types of services that CMS does not consider “telehealth”. These include: Remote Communication Technology, Virtual Check-In, Remote Evaluation of Pre-Recorded Patient Information and Interprofessional Internet Consultation.
Help Me Understand Medicare Reimbursement for Telehealth:
- Prior to the COVID-19 pandemic, there were a large number of restrictions placed on Fee-for-Service Medicare reimbursement for telehealth services. These restrictions included:
- The originating site(location of the patient). Providers could only get reimbursed for telehealth services if the patients receiving those services were located at specific types of facilities (e.g., hospitals, FQHCs, physician and practitioner offices) AND those facilities were located in specific geographic locations. There were a few exceptions to this rule, including treatment for Substance Use Disorder, Telestroke and Dialysis for End-State Renal Disease)
- The distant site practitioner (type of provider providing the telehealth service). Only a specific subset of provider types were eligible to serve as distant site providers (e.g., Physicians, NPs, PAs). FQHCs and RHCs were specifically excluded from being able to serve as distant site practitioners.
- Types of service. Only a limited set of HCPCS/CPT Codes were eligible for telehealth reimbursement. Fee for Service Medicare and Telehealth Reimbursement
Help Me Understand Private Payer Reimbursement for Telehealth:
Most of the states in the MATRC region (DC, DE, KY, MD, NJ, VA) have passed “parity legislation”, meaning that if a service being provided and billed for is considered a covered service in a face to face situation, a commercial carrier may not deny coverage solely because the service was provided via telehealth.
A few states in the MATRC region do not have parity legislation (NC, PA, WV). For these states, it is up to the carrier to set its own policies regarding coverage. In this case, you would need to contact each commercial payer to ascertain their coverage policy. In response to the pandemic, several health plans that serve our region have announced that they will make telehealth more widely available or are offering telehealth services for free for a certain period of time. These are the ones that have come to our attention to date:
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- AmeriHealth New Jersey – COVID-19 Service Enhancements
- CareFirst – COVID-19 Service Enhancements
- Cigna – COVID-19 Service Enhancements
Not all commercial carriers have the same schema regarding modifiers or POS codes. If guidance about billing codes is not provided in the above links and/or if your plan is not listed above, you will unfortunately need to contact each plan to find out which modifier or POS codes that they want you to use to indicate a telehealth visit.
The Virginia Ryan White HIV/AIDS Part B (RWHAP B) program asks all of its partners and consumers to be prepared ahead of any emergency situation that may impact and affect the Commonwealth. To assure adequate medication supplies, we ask all providers and consumers to assess medication refill needs before the emergency situation is affecting Virginia. If consumers access medications at local health departments, mail order, or retail pharmacies, encourage and help them have peace of mind and get refills now. People Living with HIV (PLWH) may be displaced within Virginia if a region is impacted (such as the eastern and central regions), as well as from out-of-state if they evacuate to Virginia. To help everyone be prepared, VDH has created new tabs on the Ryan White program sites for “Emergency Preparedness/COVID-19”. You will find information, policies, procedures, and forms to help PLWH who need emergency services during this event. If you need to provide emergency services during or after the emergency situation, the information you need is in a convenient location on this page and the VA MAP web page. VDH encourages you to always stay safe and please reach out to the RWHAP B team if you have any questions or need additional information.
COVID-19 Response for VA MAP
For more information about coronavirus in Virginia, please use this link to the Virginia Department of Health, www.vdh.virginia.gov/coronavirus. Up-to-date information on the status of the virus outbreak is available from the Centers for Disease Control and Prevention (CDC).
For other medication access concerns or questions related to eligibility, contact the VA MAP hotline toll free at 1-855-362-0658.
If you are a medication access site and have any questions related to placing medication orders for clients on the Direct Medication Assistance Program (Direct MAP), please call Central Pharmacy at 804-786-4326.
If you are a Ryan White Part B provider and have questions about services other than medication access, please contact your HIV Services Coordinator.