COMMONWEALTH OF VIRGINIA
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Notice of Intent to Revise Targeted Case Management Reimbursement Methodology
Notice is hereby given that the Department of Medical Assistance Services (DMAS) intends to modify its reimbursement methodology for targeted case management services pursuant to the Department’s authority under Title XIX of the Social Security Act. This notice is intended to satisfy the requirements of 42 C.F.R. Section 447.205 and of Section 1902(a)(13) of the Social Security Act, 42 U.S.C. Section 1396a(a)(13). All of the changes contained in this public notice are occurring in response to the Interim Final Rule with Comment Period published by the Centers for Medicare and Medicaid Services on December 4, 2007.
The current reimbursement methodology for targeted case management under the State Plan for Medical Assistance Services is codified in state regulations at 12 VAC 30-80-110 and 12 VAC 30-80-111. In most instances, DMAS reimburses a daily or monthly rate. The new CMS rule requires state Medicaid agencies to reimburse targeted case management using 15 minute units. The recently approved reimbursement methodology for substance abuse case management already requires a 15 minute unit. CMS has instructed states that it will be necessary to identify the types of costs used to build the rate and the unit of service in the State Plan. States must also assure that billed time does not exceed available productive time by practitioner through maximum service hours.
This amendment is estimated to neither increase nor decrease total annual Medicaid spending.
A copy of this notice is available for public review from William Lessard, Director, Provider Reimbursement 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 Mr. Lessard and such comments are available for review at the same address.