What is the procedure for a child who is currently in a CSA-funded residential placement and reviewed by WVMI, but at a future point becomes Medicaid eligible?
If a child is eligible for Medicaid, the facility is a Medicaid provider, and Medicaid reimbursement has been preauthorized by WVMI, no further CSA-UM reviews are required. WVMI would follow the protocol for Medicaid utilization review. The provider would need to request preauthorization from WVMI for Medicaid reimbursement, and follow the policy and procedures described in the Virginia Department of Medical Assistance Services Psychiatric Services Manual. The locality is responsible for providing the facility with the required documentation as noted in the above manual.
