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 May 24, 2024

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 — Inpatient Care (12 VAC 30-70).  

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-Inpatient Care (12 VAC 30-70)

1. In accordance with Item 288.HH.5 of the 2024 Appropriations Act, the state plan is being amended to revise reimbursement methodologies for Psychiatric Residential Treatment Facilities (PRTFs) rates to implement inflation increases for each fiscal year to be effective July 1, 2024. Inflation rates shall be tied to the Nursing Facility Moving Average as established by IHS Markit (or its successor). The most recent four quarters will be averaged to create the PRTF inflation rate.

There is no expected increase or decrease in annual fee-for-service aggregate expenditures in federal fiscal year 2024 or 2025.

2. To correct language to be consistent with current DMAS policies and regulations, the state plan is being revised to remove two phrases that pertain to adjustment factors for Type Two hospitals that were not authorized by the Virginia General Assembly or approved by CMS for addition to the state plan.  As stated below, there are no costs associated with these changes because the phrases were unauthorized errors.

There is no expected increase or decrease in annual fee-for-service aggregate expenditures in federal fiscal year 2024 or 2025.

3. In accordance with Item 288.PP.2 of the 2024 Appropriations Act, the state plan is being revised to make hospital supplemental payments for freestanding children’s hospitals with greater than 50 percent Medicaid utilization in 2009 to replace payments that have been reduced due to the federal regulation on the definition of uncompensated care costs effective June 2, 2017 equal the greater of what would have been paid to the freestanding children’s hospitals under the current uncompensated care formula or $16,000,000 annually, the average due by formula prior to Medicaid expansion without regard to the uncompensated care cost limit.

The expected increase in annual aggregate fee-for-service expenditures is $1,960,400 in state general funds and $2,039,600 in federal funds in federal fiscal year 2024 and  $7,841,600 in state general funds and $8,158,400 in federal funds in federal fiscal year 2025.