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 — 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

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

Methods & Standards for Establishing Payment Rates-Other Types of Care (12 VAC 30-80)

1. In accordance with Item 288.FFFFF.2, 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 by three percent. (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, and Benefits Planning provided under home and community- based waivers. These increases are not included in the state plan amendment but via waiver  documentation.)

The expected increase in annual fee-for-service aggregate expenditures is $16,490 in state general funds and $17,154 in federal funds in federal fiscal year 2025, and $100,995 in state general funds and $103,199 in federal funds in federal fiscal year 2026.

2. In accordance with Item 288.GGGGG.2, the state plan is being revised to increase the rates for agency- and consumer-directed personal care under the Early Periodic Screening, and Diagnosis and Treatment (EPSDT) benefit by two percent.  (A corresponding rate increase of two percent 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 fee-for-service aggregate expenditures is $109 in state general funds and $112 in federal funds in federal fiscal year 2025, and $660 in state general funds and $673 in federal funds in federal fiscal year 2026.

3. 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 emergency department. This payment shall be unbundled from the hospital rate.

The expected increase in annual fee-for-service aggregate expenditures is $841 in state general funds and $1,980 in federal funds in federal fiscal year 2025, and $3,372 in state general funds and $7,939 in federal funds in federal fiscal year 2026.

4. In accordance with Item 288.PPPPP, the state plan is being revised to ensure the reimbursement for a service provided by a licensed certified midwife or licensed midwife shall be in the same amount as the Medicaid reimbursement paid a licensed physician or certified nurse midwife, whichever is higher, for performing such service in the area served.

The expected increase in annual fee-for-service aggregate expenditures is $2,713 in state general funds and $3,554 in federal funds in federal fiscal year 2025, and $10,850 in state general funds and $14,215 in federal funds in federal fiscal year 2026.

5. In accordance with Item 288.UUUUU, the state plan is being revised to increase the rates by 6.5 percent for Office Based Addiction Treatment, Opioid Treatment Services, Partial Hospitalization Services, and Intensive Outpatient Services.

The expected increase in annual fee-for-service aggregate expenditures is $6,177 in state general funds and $23,430 in federal funds in federal fiscal year 2025, and $35,208 in state general funds and $133,554 in federal funds in federal fiscal year 2026.

6. In accordance with Item 288.WWWWW, the state plan is being revised to provide supplemental payments for dentists employed by or contracted with Virginia Commonwealth University's School of Dentistry. The total supplemental payment shall be based on the average commercial rate as approved by the federal Centers for Medicare and Medicaid (CMS) and all other Medicaid payments subject to such limit made to such dentists. DMAS shall enter into a transfer agreement with Virginia Commonwealth University for such supplemental payments, in which the University shall provide the non-federal share in order to match federal Medicaid funds for the supplemental payments.

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 $854,417 in state general funds and $1,712,833 in federal funds in federal fiscal year 2026.

7. 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 outpatient 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 $1,361,651 in state general funds and $2,747,310 in federal funds in federal fiscal year 2026.