September 2026 Newsletter

Sentara Health Plan Premium Payment Update

The Program recently learned that Sentara Health Plan may restrict premium payments made by third-party organizations unless they are recognized as qualified and authorized payers. While only one Program payment has been rejected to date, we are working with Sentara and potentially impacted families to establish the Program as an authorized payer and support continued direct payment of premiums. 

In the meantime, families may pay their child's premium directly, if needed, and seek reimbursement from the Program through the usual process. A more detailed email about this issue was sent to all families earlier this week. We will share additional updates as we learn more. 

Cancellation Fee Reimbursement

We recognize that missed appointments happen. Retroactive to July 1, the Program will cover reasonable cancellation fees when families need to cancel medical appointments. 

To request reimbursement, pay the cancellation fee and submit a reimbursement request through Rising. Please upload your cancellation receipt as proof of payment and select the "Physician" claim category. If you have questions, please contact your Case Specialist. 

Open Enrollment Reminder 

As Open Enrollment approaches, please provide your Case Specialist with any health insurance changes for 2027, along with current documentation showing your monthly premium and any past-due balance. 

While the Program pays eligible premiums on your behalf, we do not receive notices from insurance carriers about rate increases, policy changes, or past-due amounts. Staying in contact with your insurance carrier and the Program can help prevent payment issues, lapses in coverage, or cancellation. 

Vehicle Claim Reminder 

Most vehicle-related expenses are handled directly by the Program rather than through Rising. Apart from vehicle insurance and personal property tax, please submit vehicle-related expenses directly to your Case Specialist for processing. 

If you receive a denial notice from Rising for a vehicle-related claim, it may be because the expense is being handled directly by the Program. You do not need to resubmit it through Rising. If you are unsure about the status of a claim, please contact your Case Specialist. 

Disability Support Benefit 

Planning for Age 18 

As your child approaches age 18 and becomes eligible for the Disability Support Benefit, you may have questions about planning for adulthood. Families may find helpful resources through The Arc of Northern Virginia on supported decision-making, guardianship, conservatorship, and other considerations as you plan for the future. 

2026 Payment & Clarification Reminder 

The 2026 Disability Support Benefit is $3,235.83 per month. The new rate became effective in March, with retroactive adjustments for January and February included in the March payment. A $50 overpayment in April was corrected in the May payment. The standard monthly benefit will remain $3,235.83 for the remainder of 2026.

Patient and Caregiver Nursing Form Reminder

If you currently have a previous nursing order form on file, a new Patient and Caregiver Nursing Form must be completed when your current order reaches its expiration date.

Once the new Patient and Caregiver Nursing Form has been submitted, it only needs to be resubmitted if there are changes to the participant’s care needs, nursing services, or caregiver information.

The current Patient and Caregiver Nursing Form is available on the Virginia Birth Injury Fund website.

Interim Policies and reasonableness benchmarks

As many families are aware, recently enacted legislation made numerous changes to the Program's governance, operations, and benefits. The changes include adding new benefits, expanding existing benefits, and removing "any policy, rule, or guideline that extinguishes, limits, caps, or unreasonably delays payment of benefits to admitted claimants…". For most benefits, the new standard is reasonable and medically necessary. The Program's Interim Policies bring benefits administration into alignment with the legislation and will apply until they are replaced by regulations or final policies.

Some sections of the Interim Policies include reasonableness benchmarks, e.g.:

• Policy 7.3: Lodging, meals, and incidentals for overnight travel includes a reasonableness benchmark of 1.3 times the General Services Administration's (GSA) lodging rate for the destination
• Policy 11: Vehicles includes reasonableness benchmarks for when Program vehicles may need to be replaced (80,000 miles for wheelchair-accessible vans and 120,000 miles for other vehicles)

Benchmarks included in the Interim Policies are general indicators of reasonableness, not caps or limits. We understand that medically necessary and reasonable expenses may differ from the benchmarks, and the Program is committed to working with families to assess reasonableness on an individual basis, as necessary. Families needing individualized consideration should reach out to their Case Specialist.

As always, we are grateful to all families who have provided feedback on the Interim Policies and we continue to welcome all feedback, which will help the Program refine final policies and regulations for the benefit of all families. Please reach out to your Case Specialist with any questions or feedback.

Update on caregiving policy development

We began working on caregiving policy development in July and expect to make significant changes to the Interim Policies on caregiving this fall. We are conducting research and analyzing data with the goal of establishing reasonable benchmark rates for family, independent, and agency caregivers.

Any approved caregiver rate increases will be applied retroactively to July 1, 2026, and no caregiver will receive less than their current rate because of these policy changes. We are also considering a methodology for annual increases to benchmark rates and coverage of other reasonable caregiving expenses, including payroll support for families using independent caregivers.

We are grateful to the Family Advisory Committee (FAC), which provided valuable input and feedback during three dedicated meetings in July and August. We will continue working with the FAC as we develop a detailed policy proposal. We also plan to share the proposal with all families for consideration and feedback before it is finalized.

We will share more information in September about the policy development process, the caregiving policy proposal, and opportunities for interested families to provide feedback.

The Virginia Birth Injury Program works closely with the Department of Medical Assistance Services (DMAS) to help ensure families receive the services and supports available to them through both programs. For participants who receive Medicaid, coordination is especially important because Medicaid is the payer of last resort. When a service is covered by both programs, the Birth Injury Program generally pays first after any primary insurance. Medicaid waiver programs may also provide services and supports that the Birth Injury Program does not cover.

Over the past nine months, our partnership with DMAS has grown significantly through more regular communication, information sharing, and collaboration. This helps our teams better understand each program and better support families in navigating available resources.

In July, DMAS staff joined us at our office to provide training for our teams on Medicaid waiver programs, eligibility, covered services, and how our programs coordinate payment responsibilities. We are grateful to DMAS for investing the time to strengthen our teams’ knowledge and our partnership and ultimately help us better serve Virginia families.

Each month, we will take a moment to highlight the people who make our work possible. This month, we’d like you to introduce you Joe Craig, Case Specialist at the Program.

“I’ve been a Social Worker for 30 years, and my career has been focused on serving people with Disabilities and Brain Injury. I’m currently working for the Program as a Case Specialist.  My role is to be a first point of contact for families, to help them navigate systems and find resources, and to be an advocate to help them get their needs met.”

Thank you for all you do for the Program, Joe!