COMMONWEALTH OF VIRGINIA
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
NOTICE OF INTENT TO AMEND
THE VIRGINIA STATE PLAN FOR MEDICAL ASSISTANCE
This Notice was posted on February 16, 2021
Pursuant to 42 CFR 440.386, the Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to seek approval from the Centers for Medicare and Medicaid Services (CMS) of a state plan amendment (SPA) to modify two Alternative Benefit Plans (ABP) authorized under section 1937 of the Social Security Act. The first ABP relates to individuals aged 19 to 64 who are eligible for Medicaid pursuant to section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. The second ABP relates to Medicaid Works, a work incentive opportunity for individuals with disabilities.
The state plan is being revised to include reimbursement for coverage for routine patient costs furnished in connection with a member’s participation in a qualifying clinical trial in accordance with the Centers for Medicare and Medicaid Services (CMS) State Medicaid Director (SMD) letter #21-005. Per the SMD letter, DMAS will cover any item or service provided to the individual under the qualifying clinical trial, including any item or service provided to prevent, diagnose, monitor, or treat complications resulting from participation in the qualifying clinical trial, to the extent that the provision of such items or services to the beneficiary would otherwise be covered outside the course of participation in the qualifying clinical trial under the state plan or waiver, including a demonstration project under section 1115 of the Social Security Act. Such routine services and costs also include any item or service required to administer the investigational item or service.
Any service limits or cost sharing currently authorized under the approved Medicaid State Plan will apply to the ABP. The proposed ABP amendments will apply to Early Periodic Screening, Diagnoses, and Treatment (EPSDT) program benefits available under the Virginia State Plan for individuals under the age of 21.
DMAS is soliciting input from stakeholders, providers and beneficiaries on the potential impact of the proposed state plan amendment. Written comments or inquiries may be submitted within 14 days of this notice publication to Emily McClellan, Policy and Research Division, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, Emily.McClellan@dmas.virginia.gov or may be submitted on the Regulatory Town Hall website: http://townhall.virginia.gov/L/Forums.cfm
The State assures compliance with the provisions of Section 5006 (e) of the American Recovery and Reinvestment Act of 2009 related to Tribal populations.
To request a copy of the ABP SPA or a copy of this notice, contact Emily McClellan, epartment of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, or Emily.McClellan@dmas.virginia.gov