Admission of Medicaid MCO Beneficiaries

VHCA (2/12/2010)

The Department of Medical Assistance Services (DMAS) has requested our assistance in distributing information related to the admission of residents enrolled in a Medicaid Managed Care Organization (MCO).  MCO participants are the same as fee for service participants when it comes to an admission to a nursing facility (NF) in the Commonwealth.  NF's should feel comfortable in taking these admissions as long as they remember the following guidelines.

• The NF needs to complete and send in their PIRS form to DMAS for processing on these cases just as they would any other Medicaid admission.  The PIRS data entry is what triggers the DMAS system to move them out of MCO coverage and back into fee for service coverage.
• This change over can't take place unless the NF initiates the process through the use of the PIRS.

NFs with questions regarding this process should call the LTC Division of DMAS at 804.225.4222 for assistance.