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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 the State Plan - 2020 Provider Reimbursement Changes
Date Posted: 5/20/2020
Expiration Date: 7/31/2020
Submitted to Registrar for publication: YES
30 Day Comment Forum is underway. Began on 5/20/2020 and will end on 6/19/2020   [1 comments]

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 20, 2020

 

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 — Other Types of Care (12 VAC 30-80) and Methods & Standards for Establishing Payment Rates for 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 Ms. 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-Other Types of Care (12 VAC 30-80)

 

1.     In accordance with HB30, Item 313.SSSS(1), the state plan is being revised to increase the rates for agency and consumer directed personal care, respite and companion services for the Early Periodic Screening, and Diagnosis and Treatment (EPSDT) program by five percent.  These increases will also affect rates utilized in HCBS waivers.

 

The expected increase in annual aggregate expenditures for EPSDT is $6,229,299 in state fiscal year 2021, including managed care.  The expected increase in total expenditures, including HCBS waivers, is $49,834,388.

 

2.     In accordance with HB30, Item 313.HHHH, the state plan is being revised to implement a supplemental disproportionate share hospital (DSH) payment for Chesapeake Regional Hospital up to its hospital-specific disproportionate share hospital limit (OBRA '93 DSH limit) as determined pursuant to 42 U.S.C. Section 1396r-4. The payment shall be made annually based upon the hospital's disproportionate share limit for the most recent year for which the disproportionate share limit has been calculated subject to the availability of DSH funds under the federal allotment of such funds to the department.

 

The expected increase in annual aggregate expenditures is $12,000,000 in state fiscal year 2021.

 

3.     In accordance with HB30, Item 313.III(2), the state plan is being revised to create additional hospital supplemental payments for freestanding children's hospitals with greater than 50 percent Medicaid utilization in 2009 to replace payments that have been reduced due to the federal regulation on the definition of uncompensated care costs effective June 2, 2017. These new payments shall equal what would have been paid to the freestanding children's hospitals under the current disproportionate share hospital (DSH) formula without regard to the uncompensated care cost limit. These additional hospital supplemental payments shall take precedence over supplemental payments for private acute care hospitals. If the federal regulation is voided, DMAS shall continue DSH payments to the impacted hospitals and adjust the additional hospital supplemental payments authorized in this paragraph accordingly.

 

There is no expected increase or decrease in annual aggregate expenditures related to this change.

 

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

 

4.     In accordance with HB30, Item 313.LLLL, the state plan is being revised to establish Specialized Care operating rates for fiscal years 2021 by inflating the fiscal year 2020 rates using Virginia nursing home inflation.

 

There is no expected increase or decrease in annual aggregate expenditures related to 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