Department of Medical Assistance Services

1. Department of Medical Assistance Services Discuss Office of Behavioral Health The mission of the OBH is to provide high quality, person-centered, recovery based, and appropriate behavioral health and substance abuse services to Virginia Medicaid and CHIP participants. The operation of the CMH Waiver fits well within the mission of the OBH, and is a critical part of the agency’s strategic plan to increase community-based options for children with behavioral health needs, and reduce dependency on institutional settings. The OBH was created in January 2010 to oversee policy and operations of Medicaid-funded behavioral health services. Discuss Office of Behavioral Health The mission of the OBH is to provide high quality, person-centered, recovery based, and appropriate behavioral health and substance abuse services to Virginia Medicaid and CHIP participants. The operation of the CMH Waiver fits well within the mission of the OBH, and is a critical part of the agency’s strategic plan to increase community-based options for children with behavioral health needs, and reduce dependency on institutional settings. The OBH was created in January 2010 to oversee policy and operations of Medicaid-funded behavioral health services.

2. This presentation is to facilitate training of the subject matter in portions of the Virginia Medicaid manuals Training material contains only highlights of manuals and is not meant to substitute for or take their place For a complete copy of any manual:

3. A combination of therapeutic services for children & adolescents in a residential setting. Only programs with 16 or fewer beds are eligible to provide this service. This service provides the child with structure for: Daily activities Psycho-educational activities Therapeutic supervision Psychiatric treatment to ensure the attainment of therapeutic mental health goals as identified on the treatment plan

4. Specific Provider Requirements Daily reimbursement rate of $119.20Daily reimbursement rate of $119.20

5. Program Director: QMHP with bachelor’s degree one year direct work experience with mental health clients Employed full time Direct Care Staff: 50% must meet DMAS para-professional criteria Staff QualificationsLEVEL A

6. Specific Provider Requirements Daily reimbursement rate of $158.93 Daily reimbursement rate of $158.93

7. Clinical Director: LMHP Caseload not to exceed 16 clients (all sites) Program Director: QMHP with bachelor’s degree one year clinical experience Employed full time Direct Care Staff: 50% must meet DMAS para-professional criteria Staff QualificationsLEVEL B

8. Staff-Child Ratio LEVEL A 1 to 6 = day 1 to 10 = night (when children are scheduled to be asleep)

9. Medical Necessity Criteria (Level A & B) Individuals qualifying for this service must demonstrate medical necessity for the service arising from a condition due to mental, behavioral, or emotional illness, which results in significant functional impairments in major life activities in the home, school, at work, or in the community. The service must reasonably be expected to improve the child’s condition or prevent regression so that the services will no longer be needed. CAFAS= Child & Adolescent Functional Assessment ScaleCAFAS= Child & Adolescent Functional Assessment Scale

10. Medically stable Require intensive interventions in order to comply with mental health treatment Needs cannot be met with a less intense service Service at this level is expected to improve the child’s condition or prevent regression Medical Necessity Criteria (Level A & B)

11. Medical Necessity Level A & B (cont’d) An assessment must be completed at admission that documents two areas of moderate impairment in major life activities. For CSA children, CANS must be completed by the locality and be current within 30 days of placement For Non-CSA children, 2 areas of moderate impairment within past 30 days must be documented by an independent referring clinician and included in the medical record that demonstrates medical necessity criteria.

12. Medical Necessity Level A & B (cont’d) A moderate impairment is defined as a major or persistent disruption such as……. Frequent conflict in the family setting such evidenced by credible threats of physical harm (more than expected based on the child’s age / developmental level Frequent inability to accept age appropriate direction & supervision Both/either at home, school, and community Specific examples (listed in the manual): caretakers, family members at school or in the home or communitySpecific examples (listed in the manual): caretakers, family members at school or in the home or community

13. Severe difficulties in socialization such as; Significant avoidance of appropriate social interaction * Deterioration of existing relationships * Refusal to participate in therapeutic interventions Impaired ability to form a trusting relationship with at least one caretaker in the home, school, or community. Limited ability to consider the effect of one’s inappropriate conduct on others and interactions consistently involving conflict, which may include impulsive or abusive behaviors. Moderate Impairment

14. Certification done by Independent Team CSA children: FAPT Team and Physician identification of the need for service *** Coordination should occur with the child’s EPSDT provider (PCP) The placing agent must give the provider the name and FIPS (locality) code The dated signatures define the CON completion date. At least one member of the independent certifying team must have pediatric mental health experience. FAPT= Family Assessment and Planning Team’s CPMT=Community Policy and Management Team’s At least one member of the independent certifying team must have pediatric mental health experience. FAPT= Family Assessment and Planning Team’s CPMT=Community Policy and Management Team’s

15. Certificate of need-- Child-specific description documenting that-- Ambulatory care resources (all available modalities of treatment less restrictive than inpatient treatment) available in the community do not meet the treatment needs of the recipient; Proper treatment of child’s psychiatric condition requires this type program These services can reasonably be expected to improve child’s condition (so that service is no longer needed) or prevent further regression

16. Additional required written documentation must include all of the following: Description of problem behavior(s), symptoms Must relate to diagnosis (Axis 1 disorder) Immediately prior to admission (30 days) Alternative placements attempted/ explored with results of each Level of family support Clarify that manual currently state seven -----but will be changed to 30 days prior to admissionClarify that manual currently state seven -----but will be changed to 30 days prior to admission

17. Non-CSA children: Independent assessment team consisting of LMHP (not affiliated with the residential provider) and Child’s EPSDT provider (PCP) if the child/adolescent is away from home and cannot access the PCP/EPSDT screener, another physician who has knowledge of him/her may substitute Independent Team Certification of Need for Levels A & B (cont’d) Notes on eligibility: For an individual who is already a Medicaid recipient when he/she is admitted to a facility/program, certification must be made by an independent certifying team prior to admission that includes a licensed physician: - Who has competence in the tx of pediatric mental illness Who has knowledge of the recipient’s mental health history and current situation Who signs and dates the certification along with the team **** note- for CSA children, the majority of the FAPT and a physician must sign and date the certification. For NON- CSA children, the LMHP and a physician must sign and date the certification. FOR A RECIPIENT WHO HAS APPLIED FOR MEDICAID WHILE INPT IN THE FACILITY/PROGRAM The certification must Be made by the team responsible for the CIPOC Cover any period of time before the application for Medicaid eligibility for which claims for reimbursement by Medicaid are made; and Be signed and dated by a physician and the team Notes on eligibility: For an individual who is already a Medicaid recipient when he/she is admitted to a facility/program, certification must be made by an independent certifying team prior to admission that includes a licensed physician: - Who has competence in the tx of pediatric mental illness Who has knowledge of the recipient’s mental health history and current situation Who signs and dates the certification along with the team **** note- for CSA children, the majority of the FAPT and a physician must sign and date the certification. For NON- CSA children, the LMHP and a physician must sign and date the certification. FOR A RECIPIENT WHO HAS APPLIED FOR MEDICAID WHILE INPT IN THE FACILITY/PROGRAM The certification must Be made by the team responsible for the CIPOC Cover any period of time before the application for Medicaid eligibility for which claims for reimbursement by Medicaid are made; and Be signed and dated by a physician and the team

18. Initial Plan of Care (IPOC) Level A: The Initial Plan of Care (IPOC) must be completed by the QMHP and must also be signed and dated by the program director within 24 hours of admission. Level B: The Initial Plan of Care (IPOC) must be completed by the LMHP and must be signed and dated within 24 hours of admission. 12VAC30-130-890.I. For Community-Based Services for Children and Adolescents under 21 (Level A), the initial plan of care must be completed at admission by the qualified mental health professional (QMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the QMHP no later than 30 days after admission. The assessment must be signed and dated by the program director. Covers the 1st 30 days of treatment 12VAC30-130-890.H. For Therapeutic Behavioral Services for Children and Adolescents under 21 (Level B), the initial plan of care must be completed at admission by the licensed mental health professional (LMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the LMHP no later than 30 days after admission. The assessment must be signed and dated by the LMHP. 12VAC30-130-890.I. For Community-Based Services for Children and Adolescents under 21 (Level A), the initial plan of care must be completed at admission by the qualified mental health professional (QMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the QMHP no later than 30 days after admission. The assessment must be signed and dated by the program director. Covers the 1st 30 days of treatment 12VAC30-130-890.H. For Therapeutic Behavioral Services for Children and Adolescents under 21 (Level B), the initial plan of care must be completed at admission by the licensed mental health professional (LMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the LMHP no later than 30 days after admission. The assessment must be signed and dated by the LMHP.

19. The IPOC must include: 1. Diagnoses, symptoms, complaints & complications indicating the need for admission; 2. A description of the functional level of the child; 3. Treatment objectives with short-term and long-term goals; 4. A listing of any medications, treatments (therapeutic interventions) recommended for the health and safety of the patient; 5. Plans for continuing care, including review and modification to the plan of care; and 6. Plans for discharge. 12VAC30-130-890.I. For Community-Based Services for Children and Adolescents under 21 (Level A), the initial plan of care must be completed at admission by the qualified mental health professional (QMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the QMHP no later than 30 days after admission. The assessment must be signed and dated by the program director. Covers the 1st 30 days of treatment 12VAC30-130-890.H. For Therapeutic Behavioral Services for Children and Adolescents under 21 (Level B), the initial plan of care must be completed at admission by the licensed mental health professional (LMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the LMHP no later than 30 days after admission. The assessment must be signed and dated by the LMHP. 12VAC30-130-890.I. For Community-Based Services for Children and Adolescents under 21 (Level A), the initial plan of care must be completed at admission by the qualified mental health professional (QMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the QMHP no later than 30 days after admission. The assessment must be signed and dated by the program director. Covers the 1st 30 days of treatment 12VAC30-130-890.H. For Therapeutic Behavioral Services for Children and Adolescents under 21 (Level B), the initial plan of care must be completed at admission by the licensed mental health professional (LMHP) and a comprehensive individual plan of care (CIPOC) must be completed by the LMHP no later than 30 days after admission. The assessment must be signed and dated by the LMHP.

20. The IPOC must include:  1. Diagnoses, symptoms, complaints & complications indicating the need for admission; 2. A description of the functional level of the child; 3. Treatment objectives with short-term and long-term goals; 4. A listing of any medications, treatments (therapeutic interventions) recommended for the health and safety of the patient; 5. Plans for continuing care, including review and modification to the plan of care; and 6. Plans for discharge.

21. The Comprehensive Individualized Plan of Care (CIPOC) Be based on a Diagnostic evaluation; Be based on input from school, home, other healthcare providers, the child, and family (or legal guardian); Must Include Measurable short-term and long-term goals and objectives, with target dates for achievement;

22. CIPOC (cont’d) Integrated program of therapies, activities, experiences designed to meet treatment objectives Comprehensive discharge plan to include: -- Community services to insure continuity of care after discharge -- Family -- School Signed and Dated (QMHP for Level A– LMHP for Level B)

23. Reviewed every 30 days: Client’s response to services Recommend changes to CIPOC indicated by the child’s response to ISP interventions Need for continuation of services Individualized Signed and Dated by (QMHP for Level A– LMHP for Level B). CIPOC (cont’d)

24. Required Activities (A & B) Provide intensive supervision & structure of daily living activities to address specific functional/behavioral deficits as indicated in the IPC & CIPOC Treatment delivered in accordance with the CIPOC (i.e. focused on functional problems & skill acquisition).

25. Required Activities (A &B), (cont’d) Psycho-educational program Activities – 7 per week (minimum). These may be: - Anger management - Social skill building - Family living skills - Communication skills - Stress management - Development/maintenance of ADL skills related to mental health treatment needs

26. Required Activities (A & B), (cont’d) Daily documentation of all services must clearly reflect behaviors, activities, and treatments that indicate attention to and movement towards stated goals and objectives in the CIPOC Program sessions must be documented at the time the service is rendered and must be signed and dated by the qualified staff rendering the service;

27. Weekly individual psychotherapy Provided by LMHP Preauthorized Coordinate care (including discharge) with other providers Required Activities (A & B) (cont’d)

28. Therapeutic Passes Purpose is to assess recipient’s ability to function appropriately within the family & community Must be part of CIPOC Goals of a particular visit must be documented prior to granting the pass. Response documented upon return Must begin with short periods (2-4 hours) and progress to overnight passes Active therapeutic services while on overnight passes is required to bill for days away from the facility

29. Therapeutic Passes (cont’d) Overnight pass only after successful day passes Overnight passes only as part of discharge plan Outcomes of therapeutic leave must be documented No more than 24 overnight passes annually (service year, A & B Levels) Billable only if active therapeutic services take place while on leave days.

30. Discharge Criteria Less intensive service will achieve/ maintain stabilization Level of functioning has improved With respect to goals outlined in CIPOC Child can reasonably be expected to maintain these gains at lower level of treatment Child no longer benefits from service As evidenced by lack of progress toward CIPOC goals for 60 days InterQual® Behavioral Health criteria and Community Based Treatment criteria is no longer met.

31. Non-Covered Services Room and board Academic costs Personal Care Non-mental health needs

32. Limitations Services can only be provided in facilities/programs with no more than 16 beds Total number of beds is determined by including all beds located within the program/facility and on any adjoining campus or site

33. Limitations (cont’d) If provider operates separate residences that are in different areas of a LOCALITY, the bed count only applies to each residence—each residence that is 16 beds or less is eligible for Medicaid reimbursement Programs/facilities that only provide independent living services are not reimbursable Prior authorization is required through KePRO for payment of all residential services billed to Medicaid.

34. Prior Authorization for Medicaid Reimbursement For Levels A&B – Initial Review Effective July 1, 2008 Prior Authorization required. PA is required within 3 business days of admit CON signed by “team” completed prior to admit CSA-3 members of FAPT and MD NON-CSA-independent LMHP and MD UAI-2 moderate impairments-current to 30 days of admit CSA-CANS by locality NON-CSA-Assessment-PCP/EPSDT Provider and independent LMHP Clinical information needed from provider for authorization Initial Review • For Level A & B services, individuals must have a primary diagnosis of mental illness that meets the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for an Axis I disorder. All 5 axes are required to be documented in the medical record. • If this is a dual diagnosis of Mental Health (MH) and Substance Abuse Services (SAS), the focus of treatment must be the MH problem. Medicaid does not cover inpatient or residential treatment of substance abuse disorders. • Description of symptoms and behaviors within the last week. oThe symptoms and behaviors should reflect impairments that are significant enough to support the need for out-of-home placement and are anticipated to be chronic in nature, and endangering of self or others. Descriptions should be child-specific. • Description of social risk within the last month. oFailed treatments •Specifically, what service(s) had been attempted and the reason they failed. oSupport system •Brief description of deficits that support the need for a residential placement. •Description of current level of functioning oAbility to follow directions oAbility to interact appropriately with others oAbility to maintain age-appropriate behavior •Provide date of Certification of Need (CON)/Independent Team Certification, and confirmation that all required information and appropriate dated signatures are in the medical record. The CON must be completed prior to admission. •Provide the date of the Initial Plan of Care (IPC), and confirmation that all required information and appropriate dated signatures are in the medical record. The IPC must be completed within 3 days of admission. •Provide the date of the UAI (CSA-CAFAS or PECFAS) or assessment (non-CSA) for supporting placement at this level of care. This must be completed prior to the admission. If all criteria are met, KePRO will approve for 6 months Clinical information needed from provider for authorization Initial Review • For Level A & B services, individuals must have a primary diagnosis of mental illness that meets the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for an Axis I disorder. All 5 axes are required to be documented in the medical record. • If this is a dual diagnosis of Mental Health (MH) and Substance Abuse Services (SAS), the focus of treatment must be the MH problem. Medicaid does not cover inpatient or residential treatment of substance abuse disorders. • Description of symptoms and behaviors within the last week. oThe symptoms and behaviors should reflect impairments that are significant enough to support the need for out-of-home placement and are anticipated to be chronic in nature, and endangering of self or others. Descriptions should be child-specific. • Description of social risk within the last month. oFailed treatments •Specifically, what service(s) had been attempted and the reason they failed. oSupport system •Brief description of deficits that support the need for a residential placement. •Description of current level of functioning oAbility to follow directions oAbility to interact appropriately with others oAbility to maintain age-appropriate behavior •Provide date of Certification of Need (CON)/Independent Team Certification, and confirmation that all required information and appropriate dated signatures are in the medical record. The CON must be completed prior to admission. •Provide the date of the Initial Plan of Care (IPC), and confirmation that all required information and appropriate dated signatures are in the medical record. The IPC must be completed within 3 days of admission. •Provide the date of the UAI (CSA-CAFAS or PECFAS) or assessment (non-CSA) for supporting placement at this level of care. This must be completed prior to the admission. If all criteria are met, KePRO will approve for 6 months

35. Prior Authorization for Reimbursement For Levels A&B Initial Review (cont’d) For CSA cases confirmation of the 3-digit locality code. IPC-at admission by - date is start of service and to include: DSM-IV (Axes I-V) Description of symptoms and behaviors within the last thirty days. If the individual is unable to be managed safely at a less intensive level of service a statement is required identifying what service(s) were tried and how they failed.

36. Prior Authorization for Reimbursement For Levels A&B Initial Review (cont’d) Provide date of Certification of Need (CON)/Independent Team Certification. Confirm all required information and appropriately dated signatures are included on the CON. Provide date of Initial Plan of Care (IPC), confirm all required information and appropriately dated signatures included. Provide date of UAI (CSA) or assessment (non-CSA) supporting placement at this level of care.

37. Prior Authorization for Continued Stay (Concurrent) Review for Levels A&B PA prior to end of previous authorization (no earlier than 30 days) For CSA cases confirmation of the 3-digit locality code. DSM-IV-TR diagnosis. All 5 axes are required to be in the medical record. Description of symptoms and behaviors within the last month. Description of functioning within the last month. Concurrent Review (same provider) documentation must be submitted to KePRO no earlier than 30 days prior to end of current authorization • For Level A & B services, individuals must have a primary diagnosis of mental illness that meets the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for an Axis I disorder. All 5 axes are required to be documented in the medical record. • If this is a dual diagnosis of Mental Health (MH) and Substance Abuse Services (SAS), the focus of treatment must be the MH problem. Medicaid does not cover inpatient or residential treatment of substance abuse disorders. • Describe continuing or new symptoms and behaviors within the last month that support the need for residential care and that reflect the DSM-IV diagnosis. • Describe social and behavioral functioning within the last month. • Provide the date of the Comprehensive Individual Plan of Care (CIPOC) and confirmation that all required information and appropriate dated signatures are available in the medical record. The CIPOC must be completed within 30 days of admission. • Provide the date of the most recent CIPOC update (current to within past 30 days), and confirmation that all required information and appropriate dated signatures are available in the medical record. • Confirm all required therapeutic services are provided as the level of care requires. • Provide anticipated discharge plan and date. If this has changed, explain why. If all criterion are met, KePRO will approve for 6 months. Concurrent Review (same provider) documentation must be submitted to KePRO no earlier than 30 days prior to end of current authorization • For Level A & B services, individuals must have a primary diagnosis of mental illness that meets the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for an Axis I disorder. All 5 axes are required to be documented in the medical record. • If this is a dual diagnosis of Mental Health (MH) and Substance Abuse Services (SAS), the focus of treatment must be the MH problem. Medicaid does not cover inpatient or residential treatment of substance abuse disorders. • Describe continuing or new symptoms and behaviors within the last month that support the need for residential care and that reflect the DSM-IV diagnosis. • Describe social and behavioral functioning within the last month. • Provide the date of the Comprehensive Individual Plan of Care (CIPOC) and confirmation that all required information and appropriate dated signatures are available in the medical record. The CIPOC must be completed within 30 days of admission. • Provide the date of the most recent CIPOC update (current to within past 30 days), and confirmation that all required information and appropriate dated signatures are available in the medical record. • Confirm all required therapeutic services are provided as the level of care requires. • Provide anticipated discharge plan and date. If this has changed, explain why. If all criterion are met, KePRO will approve for 6 months.

38. Prior Authorization for Continued Stay (Concurrent) Review for Levels A&B (Cont’d) Provide date of CIPOC and confirm all required information and appropriately dated signatures are included on the CIPOC. Provide date of most recent CIPOC update (current to within past 30 days), and confirm all required information and appropriately dated signatures are included on the CIPOC update.

39. For Level A-- Confirm Individual psychotherapy by LMHP is provided For Level B-- Confirm Individual & Group psychotherapy by LMHP is provided Prior Authorization for Continued Stay (Concurrent) Review for Levels A&B (Cont’d)

40. Confirm 7 psychoeducational activities provided each week Confirm individual psychotherapy occurring as required Confirm daily documentation of service provision Provide anticipated discharge date. Medically necessary services will be authorized up to six months at a time Prior Authorization for Continued Stay (Concurrent) Review for Levels A&B (Cont’d)

41. Submitting a Prior Authorization (PA) Request via iEXCHANGE® The preferred method for submitting a PA request is the iEXCHANGE® web-based program Registration required Information may be found by going to the KePRO website https://dmas.kepro.org For questions call 1-888-827-2884 or email at ProviderIssues@kepro.org

42. Outpatient Psychiatric ServicesRequired For Level A & B Residential Group Home Recipients

43. Specific Provider Qualifications

44. Eligibility for Outpatient Psychotherapy Recipient demonstrates: Reduction in ability to cope or adapt Demonstrates a drastic increase in personal distress Is at risk for maladaptive coping strategies and requires treatment; Requirement for treatment to sustain behavioral or emotional gains or restore cognitive functional levels, which have been impaired; AND

45. Eligibility (cont’d) 5. Shows - deficits in peer relations or in dealing with authority or hyperactivity or poor impulse control or clinical depression or demonstrates other dysfunctional symptoms which impact concentration, the ability to learn, or participate in educational, or social activities.

46. Documentation Required in the medical record: Results of a Diagnostic Evaluation done within the past year (History) including Global Assessment Score (GAS). Description of functional limitations. Medical Evaluation (evidence of coordination with the PCP, if applicable, or documentation that it is not applicable). Plan of Care, signed and dated by the provider.

47. Documentation Required (cont’d) ** Focus of the Plan must: Be related to the diagnosis. Indicate client-specific goals related to symptoms Indicate treatment modalities used & why the modality was chosen for this individual; Indicate estimated length that treatment will be needed & frequency of the treatments Include discharge planning Must indicate participation family & caregiver as needed Plan of Care must be reviewed every 90 days or every sixth session, whichever time frame is shorter.

48. Plan of Care Review: The review may be incorporated into the progress notes, but must be identifiable as a review of the POC. It should include the following as needed: • Has there been a relapse? • Has there been a significant change in the environment? • Is the individual at risk for moving to a higher level of care? • Positive/negative changes relative to the symptoms. • Documented review of the plan of care by a qualified therapist/personnel (the provider).

49. Progress Notes for each session (must --Describe how the activities of the session relate to the client-specific goals, -Describe the therapeutic intervention -Describe the length & type of the session -Describe the level of participation in treatment Documentation Required (cont’d)

50. - Describe progress toward the goals, and the plan for the next treatment and must contain the signatures of the providers). Be signed and dated by therapist rendering service on the date of service (if unlicensed, also by supervisor) Documentation Required (cont’d)

51. Service Limits No more than three of any in this list in a seven-day period of the following: Individual psychotherapy Group psychotherapy Family psychotherapy

52. Service Limits (cont’d) Individual psychotherapy Once per day (medical evaluation & management is included in the psychotherapy code and should NOT be billed separately) Group psychotherapy Once per day 10 (max) per group No sensory stimulation, recreational activities, art classes, excursions, eating together counted Family psychotherapy Once per day

53. Prior Authorization Prior Authorization (PA) is required for all outpatient therapies. KePRO is the DMAS prior authorization contractor The preferred method is the iEXCHANGE® web-based program Forms are available on the KePRO and DMAS websites. Information is available on the KePRO website, or call 1-888-827-2884 KePRO website: https://dmas.kepro.org DMAS website: www.dmas.virginia.gov

54. Email any questions related to Behavioral Health Policy to: CMHRS@DMAS.Virginia.gov