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

General Notice
Public Notice - Intent to Amend State Plan - 2021 Institutional Provider Reimbursement Changes
Date Posted: 5/26/2021
Expiration Date: 10/26/2021
Submitted to Registrar for publication: YES
30 Day Comment Forum closed. Began on 5/26/2021 and ended 6/25/2021

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 May 26, 2021

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 Care (12 VAC 30-70) and Methods and Standards for Establishing Payment Rates – Long-Term Care (12 VAC 30-90).  

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 Emily McClellan, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, or via e-mail at:  Emily.McClellan@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 Emily McClellan 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 (www.townhall.com), on the General Notices page, found at:  https://townhall.virginia.gov/L/generalnotice.cfm

Methods & Standards for Establishing Payment Rates-Inpatient Care (12 VAC 30-70)

1.     In accordance with the 2021 Special Session, Items 313.CC, the state plan is being revised to change per diem rates paid to Virginia-based psychiatric residential treatment facilities using the provider's audited cost per day from the facility's cost report for provider fiscal years ending in state fiscal year 2018. New Virginia-based residential psychiatric facilities must submit proforma cost report data, which will be used to set the initial per diem rate for up to two years. After this period, the department shall establish a per diem rate based on an audited cost report for a 12-month period within the first two years of operation. Virginia-based residential psychiatric facilities that do not submit cost reports shall be paid at 75 percent of the established rate ceiling. If necessary to enroll out-of-state providers for network adequacy, the department shall negotiate rates. If there is sufficient utilization, the department may require out-of-state providers to submit a cost report to establish a per diem rate. In-state and out-of-state provider per diem rates shall be subject to a ceiling based on the statewide weighted average cost per day from fiscal year 2018 cost reports.

The expected increase in annual aggregate expenditures is $1,899,924 in state general funds and $1,899,924 in federal funds in federal fiscal year 2021.

2.     In accordance with the 2021 Special Session, Items 313.UU (9), the state plan is being revised to implement a supplemental inpatient payment for Lake Taylor Transitional Care Hospital based on the difference between Medicaid reimbursement and the inpatient Upper Payment Limit for non-state government owned hospitals. The department shall include in its contracts with managed care organizations a percentage increase for Lake Taylor Transitional Care Hospital consistent with the fee for service supplemental payment percentage increase. The department shall adjust capitation payments to Medicaid managed care organizations to fund this percentage increase. The originating funding for this program will come entirely from Lake Taylor for Lake Taylor.

The expected increase in annual aggregate expenditures is $1,359,319 in state general funds and $1,359,319 in federal funds in federal fiscal year 2021.

3.     In accordance with the 2021 Special Session, Items 313.BBB, the state plan is being revised to clarify that supplemental payments for graduate medical education residency slots shall be in amounts of $100,000 minus any Medicare residency payment for which the sponsoring institution is eligible. For any residency program at a facility whose Medicaid payments are capped by the Centers for Medicare and Medicaid Services, the supplemental payments for each qualifying residency slot shall be $50,000 from the general fund annually minus any Medicare residency payments for which the residency program is eligible.

There is no expected increase or decrease in annual aggregate expenditures as a result of this clarification.

4.     In accordance with the 2021 Special Session, Items 313.IIIIII (1), the state plan is being revised to adjust the formula for indirect medical education (IME) reimbursement for managed care discharges for freestanding children's hospitals with greater than 50 percent Medicaid utilization in 2009 by increasing the case mix adjustment factor to 2.718. This increased case mix index (CMI) factor shall take precedence over future rebasing. Total payments for IME in combination with other payments for freestanding children's hospitals with greater than 50 percent Medicaid utilization in 2009 may not exceed the federal uncompensated care cost limit that disproportionate share hospital payments are subject to.

The expected increase in annual aggregate expenditures is $562,500 in state general funds and $562,500 in federal funds in federal fiscal year 2021.

 

Methods & Standards for Establishing Payment Rates-Long-Term Care (12 VAC 30-90)

 1.     In accordance with the 2021 Special Session, Items 313.GGGG, the state plan is being revised to modify reimbursement for nursing facility services such that the direct peer group price percentage shall be increased to 109.3 percent and the indirect peer group price percentage shall be increased to 103.3 percent.

The expected increase in annual aggregate expenditures is $1,746,197 in state general funds and $1,746,197 in federal funds in federal fiscal year 2021.

2.     In accordance with the 2021 Special Session, Item 313.JJJJ, the state plan is being revised to provide that any nursing facility which thereafter loses its Medicaid capital reimbursement status as a hospital-based nursing facility because a replacement hospital was built at a different location and Medicare rules no longer allow the nursing home's cost to be included on the hospital's Medicare cost report shall have its first fair rental value (FRV) capital payment rate set at the maximum FRV rental rate for a new free-standing nursing facility with the date of acquisition for its capital assets being the date the replacement hospital is licensed.

The expected increase in annual aggregate expenditures is $29,989 in state general funds and $29,989 in federal funds in federal fiscal year 2021.

3.     In accordance with the 2021 Special Session, Item 313.KKKK, the state plan is being revised to increase the direct and indirect operating rates from 15 percent to 25.4 percent above a facility's calculated price-based rates where at least 80 percent of the resident population have one or more of the following diagnoses: quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy. In addition, a qualifying facility must have at least 90 percent Medicaid utilization and a case mix index of 1.15 or higher in fiscal year 2014.

The expected increase in annual aggregate expenditures is $126,726 in state general funds and $126,726 in federal funds in federal fiscal year 2021.

4.     In accordance with the 2021 Special Session, Item 313.LLLLL (1), the state plan is being revised to increase nursing home and specialized care per diem rates by $15 per day effective July 1, 2021. Such adjustment shall be made through existing managed care capitation rates as a mandated specified rate increase. DMAS shall adjust capitation rates to account for the nursing facility rate increase. The specified rate increase in this paragraph applies across fee-for-service and Medicaid managed care.

The expected increase in annual aggregate expenditures is $11,680,754 in state general funds and $11,680,754 in federal funds in federal fiscal year 2021.

5.     In accordance with the 2021 Special Session, Item 313.RRRRR, the state plan is being revised to implement a supplemental Medicaid payment for Department of Veterans Services (DVS) state government-owned nursing facilities. The total supplemental Medicaid payment for DVS state government owned nursing homes shall be based on the difference between the Upper Payment Limit of 42 CFR 447.272, as approved by the Centers for Medicare and Medicaid Services (CMS), and all other Medicaid payments subject to such limit made to such nursing homes.

The expected increase in annual aggregate expenditures is $762,714 in federal funds, $576,048 in general funds, and $2,620 in special funds in federal fiscal year 2021.

6.     In accordance with the 2021 Special Session, Item 313.GGGGGG, the state plan is being revised to defer the next scheduled nursing facility rate rebasing for one year in order to utilize the calendar year 2021 cost reports as the base year. The deferred year's rates would reflect the prior year rates inflated according to the existing reimbursement regulations.

There is no expected increase or decrease in annual aggregate expenditures as a result of this change.   

 

 

 

 


Contact Information
Name / Title: Emily McClellan  / Regulatory Manager
Address: Division of Policy and Research
600 E. Broad St., Suite 1300
Richmond, 23219
Email Address: Emily.McClellan@dmas.virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: (800)343-0634