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Department of Medical Assistance Services
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Board of Medical Assistance Services

General Notice
Public Notice: Intent to Amend Virginia State Plan for Medical Assistance - Supplemental Payments
Date Posted: 7/11/2018
Expiration Date: 12/31/2018
Submitted to Registrar for publication: YES
30 Day Comment Forum is underway. Began on 7/11/2018 and will end on 8/10/2018

LEGAL NOTICE

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

NOTICE OF INTENT TO AMEND

(Pursuant to §1902(a)(13) of the Act (U.S.C. 1396a(a)(13))

THE VIRGINIA STATE PLAN FOR MEDICAL ASSISTANCE

This Notice was posted on July 11, 2018

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates—Inpatient Hospital Services (12 VAC 30-70) and Methods and Standards for Establishing Payment Rates – Other Types of Services (12 VAC 30-80).

This notice is intended to satisfy the requirements of 42 C.F.R. § 447.205 and of § 1902(a)(13) of the Social Security Act, 42 U.S.C. § 1396a(a)(13).  A copy of this notice is available for public review from Karen Cameron, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, or via e-mail at:  karen.cameron@dmas.virginia.gov.

DMAS is specifically soliciting input from stakeholders, providers and beneficiaries, on the potential impact of the proposed changes discussed in this notice.  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Cameron and such comments are available for review at the same address.  Comments may also be submitted, in writing, on the Town Hall public comment forum attached to this notice.

This notice is available for public review on the Regulatory Town Hall on the General Notices page, found at:  https://townhall.virginia.gov/L/generalnotice.cfm

1.  Inpatient Supplemental Payments for Private Acute Care Hospitals. The 2018 Acts of Assembly directs DMAS to provide supplemental inpatient hospital payments to qualifying hospitals up to the private hospital upper payment limit for private hospitals.  Qualifying hospitals include all private acute care hospitals and exclude public hospitals, freestanding psychiatric and rehabilitation hospitals, children’s hospitals, long stay hospitals, long-term acute care hospitals and critical access hospitals.  The total supplemental payment shall be based on the difference between the private hospital inpatient upper payment limit in 42 CFR § 447.272 as approved by CMS and all other Medicaid payments subject to such limit.   Effective October 1, 2018, the department is amending the State Plan to make supplemental payments to all qualifying hospitals.  The department shall also, effective October 1, 2018, include in its contracts with managed care organizations a directed payment for qualifying hospitals consistent with the State Plan Amendment.

The expected increase in annual aggregate expenditures including managed care is $211,476,474 for state fiscal year 2019 and $604,218,496 for state fiscal year 2020. 

2.  Outpatient Supplemental Payments for Private Acute Care Hospitals. The 2018 Acts of Assembly directs DMAS to provide supplemental outpatient hospital payments to qualifying hospitals up to the private hospital upper payment limit for private hospitals.  Qualifying hospitals include all private acute care hospitals and exclude public hospitals, freestanding psychiatric and rehabilitation hospitals, children’s hospitals, long stay hospitals, long-term acute care hospitals and critical access hospitals.  The total supplemental payment shall be based on the difference between the private hospital outpatient upper payment limit in 42 CFR § 447.321 as approved by CMS and all other Medicaid payments subject to such limit.   Effective October 1, 2018, the department is amending the State Plan to make supplemental payments to all qualifying hospitals.  The department shall also, effective October 1, 2018, include in its contracts with managed care organizations a directed payment for qualifying hospitals consistent with the State Plan Amendment.

The expected increase in annual aggregate expenditures including managed care is $37,319,378 for state fiscal year 2019 and $106,626,794 for state fiscal year 2020. 

3.  Sunsetting of Other Supplemental Payments for Private Acute Care Hospitals. In order to avoid overlapping supplemental payments, the following supplemental payments to a limited group of private hospitals are being terminated on the date these new supplemental payments are effective for a broader group of private hospitals, which includes the hospitals eligible for the existing supplemental payments.

                * Supplemental Inpatient and Outpatient Payments for Private Hospital Partners of Type One Hospitals (Culpeper, Haymarket and Prince William)

            * Supplemental Inpatient Payments for Certain Teaching Hospitals (Sentara Norfolk General and Carilion Medical Center) – Item 303.XX.6.c authorizes this action.

The expected decrease in annual aggregate expenditures is $25,000,000 for state fiscal year 2019 and $100,000,000 for state fiscal year 2020. 


Contact Information
Name / Title: Karen Cameron  / Senior Project Manager
Address: 600 E. Broad Street, Suite 1300
Richmond, 23219
Email Address: Karen.Cameron@dmas.virginia.gov
Telephone: (804)298-3868    FAX: (804)786-1680    TDD: (800)343-0634