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

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.  The changes contained in this public notice are occurring in response to language in the 2007 Appropriation Act, Item 302 PPP.  The Appropriation Act directs DMAS to amend the State Plan for Medical Assistance to provide coverage of substance abuse treatment services for children and adults, effective July 1, 2007.  Rates for this new service are structured differently from those offered under mental health services, in accordance with guidance the Agency received from the Centers for Medicare and Medicaid Services (CMS).

Specifically, rate methodologies for substance abuse service providers are based upon the Agency fee schedule and existing fees applied to current providers, paying the same to public and private providers, as follows:

1. Outpatient psychotherapy services for assessment and evaluation or treatment of substance abuse furnished by physicians shall be reimbursed using the methodology in 12 VAC 30-80-190. For non-physicians, they shall be reimbursed at the same levels specified in 12 VAC 30-50-140 and 12 VAC 30-50-150.

2. Rates for other substance abuse services and case management services shall be based on the Agency fee schedule for 15 minute units of service.  For each level of professional necessary to provide services described in 12 VAC 30-50-228 and 12 VAC 30-50-461, separate rates shall be established for licensed professionals, qualified substance abuse professionals (QSAP) and paraprofessionals.  

The Agency anticipates that the implementation of this new coverage will result in increased state costs of $5.2 to $9.0 million per year in the first three years.  A copy of this notice is available for public review from Catherine Hancock, Policy and Research Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.com).  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Hancock and such comments are available for review at the same address.