As submitted by Magellan:

The Department of Medical Assistance Services and Magellan of Virginia are excited to announce changes to the Governor’s Access Plan (GAP) that will expand services to GAP members. The GAP program changes were mandated by the 2017 General Assembly. The Center for Medicare and Medicaid Services gave their final approval for these changes September 22, 2017.

Effective July 1, 2017, GAP enrollees have access to Peer Support Services. These services are provided by qualified peer support specialists that assist members with developing and implementing wellness, recovery, and resiliency goals in managing mental health and/or substance use disorders.

Also, effective October 1, 2017, the eligibility limits for household income are increasing from 80% to 100% (with an additional 5% disregard) of the federal poverty level. With this increase, more individuals may be able qualify for GAP services. The GAP eligibility application process with Cover Virginia remains the same.

In addition, effective October 1, 2017, GAP enrollees will have access to additional Addiction and Recovery Treatment Services (ARTS) including Partial Hospitalization Services (ASAM Level 2.5) and Residential treatment (ASAM Levels 3.1 through 3.7) for members who have substance use disorders. A service and billing table is listed below:

ASAM Level 2.5 S0201 or Rev 0913 with S0201 Partial Hospitalization
ASAM Level 3.1 H2034 Clinically managed low intensity residential services
ASAM Level 3.3 H0010 Rev 1002
Use modifier TG
Clinically managed population-specific high intensity residential services
ASAM Level 3.5 H0010 Rev 1002
Adult – use modifier HB
Clinically managed high-intensity residential services (Adult)
Clinically managed medium-intensity residential services (Adolescent)
ASAM Level 3.7 H2036 Rev 1002
Adult – use modifier HB
Medically monitored intensive inpatient services

 

For more information on the GAP program and how individuals apply, go to www.gap-va.org(Cover Virginia’s website), call Cover Virginia at 1-855-869-8190, call Magellan of Virginia at 1-800-424-GAP9, or email BridgetheGAP@nulldmas.virginia.gov.

For any other questions, please contact Magellan of Virginia’s  customer service at 1-800-424-4046 or use the Contact Us tool on the Magellan of Virginia website.

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