BEHAVIORAL HEALTH SERVICES PROVIDER IN VIRGINIA

Fatumata Kaba
3 days ago
4 min read

DELIVERING MENTAL HEALTH, SUBSTANCE USE, AND EMOTIONAL WELL-BEING SUPPORT THROUGH EVIDENCE-BASED, COMMUNITY-INTEGRATED CARE

Behavioral Health Services in Virginia address the mental, emotional, and behavioral needs of individuals living with psychiatric conditions, trauma, developmental challenges, or substance use disorders. These services help participants improve functioning, develop coping skills, and achieve stability in their home and community environments.

Behavioral health services may be covered through the Virginia Medicaid State Plan, CCC Plus Waiver, or Behavioral Health Redesign services. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS), with authorizations managed through Managed Care Organizations (MCOs) or Community Services Boards (CSBs).

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1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)

Role: Administers Medicaid programs, sets service definitions, and provider requirements.

Agency: Virginia Department of Behavioral Health and Developmental Services (DBHDS)

Role: Licenses behavioral health providers, oversees quality and human rights compliance.

Agency: Managed Care Organizations (MCOs)

Role: Authorize and manage Medicaid behavioral health benefits under CCC Plus and other plans.

Agency: Community Services Boards (CSBs)

Role: Coordinate services for waiver participants, refer individuals for treatment, and provide crisis support.

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Behavioral health services include mental health counseling, crisis stabilization, skill-building, and clinical support to treat psychiatric, developmental, or substance use-related conditions.

Examples of covered services:

Outpatient psychotherapy (individual, family, group)
Intensive In-Home (IIH) Services
Mental Health Skill-Building (MHSS)
Crisis Intervention and Crisis Stabilization
Applied Behavior Analysis (ABA)
Peer Support Services
Substance Use Disorder (SUD) treatment
Psychiatric medication management and telepsychiatry
Case management and care coordination

Services must be medically necessary, supervised by qualified professionals, and aligned with the Individualized Treatment Plan (ITP) or ISP.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your entity with the Virginia State Corporation Commission (SCC)
Obtain EIN and Type 2 NPI
Apply for a DBHDS Behavioral Health license under the relevant service categories (e.g., MHSS, IIH, Outpatient)
Complete DBHDS Human Rights Office affiliation
Develop a Behavioral Health Services Policy & Procedure Manual
Enroll with DMAS via the MES Provider Portal
Contract with MCOs and/or CSBs for referrals and authorizations

Note: Clinical supervisors, licensed providers, and QMHP/QPP staff must meet DBHDS credentialing requirements.

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI

Step 2: Apply for the appropriate DBHDS license(s)

Step 3: Affiliate with Human Rights and complete policies

Step 4: Enroll in Virginia Medicaid via the MES portal

Step 5: Contract with MCOs and CSBs

Step 6: Hire and credential staff; begin services upon referral and plan approval

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI
DBHDS license and Human Rights affiliation
Medicaid enrollment confirmation
Credentialing files for licensed and unlicensed staff
Behavioral Health Policy & Procedure Manual including:
- Admission criteria and clinical supervision protocols
- Treatment planning and service note templates
- Safety, risk assessment, and suicide prevention procedures
- Crisis and emergency response guidelines
- HIPAA and client rights documentation
- Quality assurance and incident reporting processes

6. STAFFING REQUIREMENTS

Role: Licensed Mental Health Professional (LMHP, LPC, LCSW, LMFT, etc.)

Requirements:

Active Virginia license
Responsible for assessments, treatment plans, and supervision

Role: Qualified Mental Health Professional (QMHP-A/C)

Requirements:

Registered with the Virginia Board of Counseling
Bachelor's degree + behavioral health experience

Role: Peer Support Specialist / Behavioral Technician (as applicable)

Requirements:

Certified by DBHDS or under clinical supervision

All staff must complete:

HIPAA and documentation training
DBHDS human rights and abuse prevention
Suicide prevention and de-escalation training
Annual clinical competencies and CEUs

7. MEDICAID WAIVER PROGRAMS & OTHER COVERAGE

Behavioral Health Services may be provided through:

CCC Plus Waiver – For adults with disabilities or behavioral health needs
CL/FIS Waivers – May include behavioral support and ABA for ID/DD individuals
Virginia Medicaid Behavioral Health Redesign – Covers enhanced services under standard Medicaid
EPSDT (Early Periodic Screening, Diagnosis, and Treatment) – For children and adolescents under age 21

Authorization and eligibility vary by service type and are determined by CSBs, MCOs, or treating physicians.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Clinical Staffing

Timeline: 2–4 weeks

Phase: DBHDS Licensing & Medicaid Enrollment

Timeline: 2–3 months

Phase: Policy Development & Contracts

Timeline: 3–5 weeks

Phase: Launch of Services

Timeline: Begins upon authorization of treatment plans

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)Website: https://www.dmas.virginia.gov

MES Medicaid Provider Enrollment Portal

Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)

Website: https://dbhds.virginia.gov

Community Services Boards Directory

Website: https://dbhds.virginia.gov/community-services-boards/

MCO Contacts (Aetna, Anthem, Molina, etc.)

Available via: https://www.virginiamanagedcare.com

BEHAVIORAL HEALTH SERVICES PROVIDER IN VIRGINIA

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA BEHAVIORAL HEALTH SERVICES PROVIDER

WCG partners with licensed clinicians and community agencies to build high-impact behavioral health programs backed by compliance, clinical integrity, and sustainability.

Scope of Work: