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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 State Plan - 2022 Non-Institutional Provider Reimbursement Changes
Date Posted: 6/30/2022
Expiration Date: 12/30/2022
Submitted to Registrar for publication: YES
No comment forum defined for this notice.

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 June 30, 2022

 

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).  

 

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 Meredith Lee, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, or via e-mail at:  Meredith.Lee@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 Meredith Lee 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 (https://townhall.virginia.gov) 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 the 2022 Special Session, Item 304.DD(7)(b), the state plan is being revised to implement supplemental physician payments for practice plans employed by or under contract with Chesapeake Regional Hospital to the maximum allowed by the Centers for Medicare and Medicaid Services. The department shall increase payments to Medicaid managed care organizations for the purpose of providing higher rates to physicians employed by or under contract with Chesapeake Regional Hospital based on the maximum allowed by CMS. The department shall revise its contracts with managed care organizations to incorporate these managed care directed payments, subject to approval by CMS.

 

The expected increase in annual aggregate expenditures is $0 in state general funds and $2,781,421 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.DDDD, the state plan is being revised to increase the rates for agency-directed and consumer-directed personal care services under the Early Periodic Screening, and Diagnosis and Treatment (EPSDT) benefit by 7.5 percent to reflect additional increases in the state minimum wage while maintaining the existing differential between consumer-directed and agency-directed rest-of-state rates as well as the northern Virginia and rest-of-state rates. (A corresponding rate increase of 7.5% will be provided for these services and for companion and respite services provided under home and community- based waivers, however, the increase is not included in a state plan amendment but via waiver  documentation.) 

 

The expected increase in annual aggregate expenditures is $4,755 in state general funds and $6,102 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.IIII(1), the state plan is being revised to increase reimbursement rates for dental services by 30 percent.

 

The expected increase in annual aggregate expenditures is $6,285,669 in state general funds, $506,734 in special funds, and $11,352,111 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.JJJJ, the state plan is being revised to increase reimbursement rates for physician primary care services, excluding those provided in emergency departments, to 80 percent of the federal FY 2021 Medicare equivalent as calculated by the department and consistent with the appropriation available for this purpose.

 

The expected increase in annual aggregate expenditures is $29,252 in state general funds, $6,162 in special funds, and $86,459 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.KKKK, the state plan is being revised to update the rates for Private Duty and Skilled Nursing under the Early Periodic Screening, and Diagnosis Treatment (EPSDT) benefit. (A corresponding rate increase will be provided for these services and for Group Homes, Sponsored Residential, Supported Living, Independent Living Supports, In-home Supports, Community Engagement, Community Coaching, Therapeutic Consultation, Group Day Support, Group Supported Employment, Workplace Assistance, Community Guide, DD Case Management and Benefits Planning provided under home and community- based waivers, using the most recent rebasing estimates, based on DMAS’ review of the model assumptions as appropriate and consistent with efficiency, economy, quality and sufficiency of care and reported no later than July 1, 2022.  Rates shall be increased according to Tiered payments contained in the rebasing model, where appropriate for the type of service provided.  These increases are not included in the state plan amendment but via waiver  documentation.)

 

The expected increase in annual aggregate expenditures is $671,439 in state general funds, $1,548 in special funds, and $875,462 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.LLLL, the state plan is being revised to increase reimbursement rates for obstetrics and gynecology covered services by 15 percent.

 

The expected increase in annual aggregate expenditures is $8,661 in state general funds, $1,227 in special funds, and $19, 907 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.MMMM, the state plan is being revised to increase reimbursement rates for children's covered vision services by 30 percent.

 

The expected increase in annual aggregate expenditures is $2,732 in state general funds, $133 in special funds, and $4,952 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.QQQQ, the state plan is being revised to increase Medicaid rates for peer recovery and family support services in private and public community-based recovery services settings from $6.50 to $13.00 per 15 minutes for individuals and from $2.70 to $5.40 per 15 minutes for groups.

 

The expected increase in annual aggregate expenditures is $2,363 in state general funds, $269 in special funds, and $4,849 in federal funds in federal fiscal year 2022.

 

  1. In accordance with the 2022 Special Session, Item 304.RRRR, the state plan is being revised to increase rates by 12.5%, relative to the rates in effect prior to July 1, 2021, for consumer-directed facilitation services, mental health and early intervention case management services, and community behavioral health and habilitation services.

 

The expected increase in annual aggregate expenditures is $347,659 in state general funds, $15,569 in special funds, and $500,533 in federal funds in federal fiscal year 2022.

 


Contact Information
Name / Title: Meredith Lee  / Policy, Regulations, and Manuals Supervisor
Address: Division of Policy and Research
600 E. Broad Street, Suite 1300
Richmond, 23219
Email Address: Meredith.Lee@dmas.virginia.gov
Telephone: (804)371-0552    FAX: (804)786-1680    TDD: (800)343-0634