Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services


chapter
Methods and Standards for Establishing Payment Rates; in-Patient Hospital Care [12 VAC 30 ‑ 70]
Guidance Documents   Periodic Reviews
Chapter Information
Description This chapter contains the reimbursement methodology for inpatient hospital services.
State Authority COV 32.1-325 et seq et seq.
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Exempt from APA No, changes to this chapter are subject to the Administrative Process Act and the standard executive branch review process.
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings

Contact Information
Name / Title: Emily McClellan  / Regulatory Supervisor
Address: Policy Division, DMAS
600 E. Broad Street, Suite 1300
Richmond, VA 23219
Email Address: Emily.McClellan@DMAS.Virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: ()-
Current Actions
Action Title Latest Stage Status
Hospital DSH Changes Fast-Track Submitted to the Registrar and awaiting publication (5/15/2017).
Modification of Indirect Medical Education Payments - -
Clarification to Medicaid Utilization Calculation to Match Cost Report Practice - -
Supplemental Payments for Inpatient/ Outpatient Hospitals - -
CH 0080 Reimbursement - Hospitals - -

Past Actions
Action Title Latest Stage Status
Institutions for Mental Disease Reimbursement Changes Final Stage complete. This regulation became effective on 3/8/2017.
All Patient-Refined DRG Payment Methodology Fast-Track Stage complete. This regulation became effective on 2/25/2016.
Supplemental Payments for Various Provider Types (Hospitals, EVMS Physicians, NFs) Fast-Track Stage complete. This regulation became effective on 11/17/2016.
2013 Reimbursement Changes Final Stage complete. This regulation became effective on 6/18/2014.
Supplemental Payments for Institutional/Non-Institutional Providers Fast-Track Stage complete. This regulation became effective on 2/13/2015.
2012 Reimbursement Methodology Changes Final Stage complete. This regulation became effective on 8/14/2013.
Provider Preventable Conditions Final Stage complete. This regulation became effective on 4/25/2012.
Outpatient Rehabilitation Agency and Long Stay Hospital Reimbursement Final Stage complete. This regulation became effective on 8/16/2012.
2011 Budget Reimbursement Changes Final Stage complete. This regulation became effective on 7/1/2011.
2011 Technical Corrections for Reimbursment Regulations Final Stage complete. This regulation became effective on 4/27/2011.
2010 Reimbursement and Provider Termination Changes Final Stage complete. This regulation became effective on 7/1/2010.
2009 Hospital, Home Health, and Nursing Facility Reimbursement Changes Final Stage complete. This regulation became effective on 3/17/2010.
2008 Reimbursement Changes Final Stage complete. This regulation became effective on 10/15/2008.
Simplify Hospital and Specialized Care Reimbursement Fast-Track Stage complete. This regulation became effective on 11/27/2008.
Clarification to Medicaid Utilization Calculation to Match Cost Report Practice Final Stage complete. This regulation became effective on 7/23/2008.
2007 Reimbursement Changes Final Stage complete. This regulation became effective on 7/1/2007.
Increase Reimbursement for Hospitals, Certain Physicians and Nursing Facilities Fast-Track Stage complete. This regulation became effective on 8/25/2007.
IME Payment Enhancement for High NICU Utilization Final Stage complete. This regulation became effective on 8/23/2006.
Modifications to Supplemental Payment Methods for Medicaid Public Providers. Final Stage complete. This regulation became effective on 8/23/2006.
Conform DSH Limit to Federal Legislation Fast-Track Stage complete. This regulation became effective on 11/6/2006.
Modification of Indirect Medical Education (IME) Payments Emergency/NOIRA Stage complete. Emergency regulation expired on 6/30/2006.
Set Inpatient Hospital Adjustment Factor to 0.76 Final Stage complete. This regulation became effective on 7/1/2005.
Eliminate DSH for NICU Programs and Modify IME Final Stage complete. This regulation became effective on 9/1/2005.
Increase in DSH Limit for FY 2005 Fast-Track Stage complete. This regulation became effective on 6/6/2005.
Inpatient Hospital Adjustment Factor Increase Fast-Track Stage complete. This regulation became effective on 7/1/2005.
Reimbursement to Type One Hospitals for Operating Costs, DSH, and Indirect Medical Education Final Stage complete. This regulation became effective on 8/12/2004.
Exclude Freestanding Psychiatric Hospitals from Inpatient Hospital Rate Rebasing Emergency/NOIRA Stage complete. Emergency regulation expired on 8/31/2005.
Reduction of Hospital Capital Costs Final Stage complete. This regulation became effective on 7/1/2004.
Modify Lump Sum Adjustment Final Stage complete. This regulation became effective on 1/4/2004.
Inflation Factor for Inpatient Hospital Reibmursement Emergency Stage complete. Emergency regulation expired on 6/30/2004.
Supplemental Payments for Inpatient and Outpatient Services Final Stage complete. This regulation became effective on 1/28/2004.
Outpatient Hospital Reimbursement and Graduate Medical Education Final Stage complete. This regulation became effective on 7/1/2003.
Reduction of Inpatient Hospital Reimbursement Rates Final Stage complete. This regulation became effective on 8/1/2003.
Limit Coverage of Out-of-State Inpatient Hospital Services Final Stage complete. This regulation became effective on 1/2/2002.
Provider Appeals Final Stage complete. This regulation became effective on 7/4/2001.
Diagnosis Related Groupings (DRG) Final Stage complete. This regulation became effective on 7/1/2000.

Withdrawn Actions
Action Title Latest Stage Status
Supplemental Payments for Private Hospital Partners -
2010 Reimbursment Changes (Stimulus) Final Stage withdrawn before submission to the Registrar.
Outpatient Rehabilitation Agency and Long Stay Hospital Reimbursement -
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