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 30, 2025

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 — In-Patient Hospital 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

In accordance with the 2025 Appropriations Act, DMAS will be making the following changes:

Methods & Standards for Establishing Payment Rates-In-Patient Hospital Care (12 VAC 30-70)

1. In accordance with Item 288.MMMMM, the state plan is being revised to include a provision for payment of medical assistance for FDA approved long-acting injectable or extended-release medications administered for a serious mental illness or substance use disorder in any hospital inpatient setting. This payment shall be unbundled from the hospital rate.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2025 or federal fiscal year 2026. 

2. In accordance with Item 288.RRRRR, the state plan is being revised to make supplemental payments through an adjustment to the formula for indirect medical education (IME) reimbursement, using managed care discharge days, not to exceed $30,000,000 total computable for teaching hospitals affiliated with Virginia Tech Carilion School of Medicine. The public entity shall transfer the non-federal share of the authorized supplemental payments. The funds to be transferred must comply with 42 CFR 433.51 and 433.54. Such funds may not be paid from any private agreements with Virginia Tech Carilion School of Medicine that are in excess of fair market value or that alleviate pre-existing financial burdens of the school. The Virginia Tech Carilion School of Medicine is authorized to use general fund dollars to accomplish this transfer. The Virginia Tech Carilion School of Medicine would enter into an Interagency Agreement with the department for this purpose and must attest to compliance with applicable CMS criteria.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2025.  The expected increase in annual fee-for-service aggregate expenditures is $8,297,630 in state general funds and $21,702,370 in federal funds in federal fiscal year 2026.

3. In accordance with Item 3-5.15, the state plan is being revised to broaden the types of hospitals that qualify for supplemental payments for inpatient services to Medicaid patients.  Specifically, all private hospitals will include critical access hospitals.  (The provider rate assessment is used to fund the state general fund of the hospital supplemental payments and the change in how private hospitals is defined will increase the number of hospitals participating in the assessment.) 

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2025.  The expected increase in annual fee-for-service aggregate expenditures is $308,224 in state general funds and $621,882 in federal funds in federal fiscal year 2026.