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 Department intends to implement a new methodology for providers of Early Intervention services pursuant to Part C of the Individuals with Disabilities Education Act (IDEA) of 2004 (20 U.S.C. § 1431 et seq.). This action is being taken pursuant to the 2009 Appropriations Act (Chap. 781), Item TTT.:
The planned regulatory action creates a new model for Medicaid coverage of Early Intervention services for children less than three years of age who are eligible for services under Chapter 53 (§ 2.2-5300 et seq.) of Title 2.2 of the Code of Virginia in accordance with Part C IDEA. In order to ensure compliance with federal Part C requirements DMAS is establishing a newly recognized provider type and specialty to provide services specifically oriented to the requirements of individuals eligible for Part C services. This specialized provider group will support the service delivery system the State adopted to provide Early Intervention services -- the Virginia Infant and Toddler Connection of Virginia (I&TC). These new regulations establish a broader range of specialized Part C providers to meet the individual child’s needs and assure that providers have the specific expertise to effectively address developmental problems in young children as provided for in Part C.
Medicaid payment for defined Early Intervention services would provide a framework for ensuring that providers of Early Intervention services through the IT&C model bill Medicaid first, if appropriate, before using Part C program funds to comply with the payor of last resort requirement contained in Part C of IDEA. Certified individuals and agencies who currently participate with the Agency shall obtain Part C designation from DMAS and bill for services as Early Intervention providers rather than as a rehabilitation agency provider or another designation. New providers shall enroll to participate with DMAS with a Part C specialty designation in order to bill for EI services.
Early Intervention services shall be reimbursed on a fee-for-service basis for non-MCO providers. All private and governmental fee-for-service providers shall be paid according to the same methodology, with separate fees for certified Early Intervention providers who are licensed as physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, speech pathologists, or registered nurses to ensure access to Early Intervention services.
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 Molly Carpenter, Division of Child and Maternal Health, DMAS, 600 Broad Street, Suite 1300, Richmond, VA 23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.virginia.gov
). Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Carpenter and such comments are available for review at the same address.