Date Posted: 11/21/2004
Expiration Date: 12/30/2004
Submitted to Registrar for publication:
No comment forum defined for this notice.
COMMONWEALTH OF VIRGINIA
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Notice of Intent to Modify Reimbursement for Durable Medical Equipment
Notice is hereby given that the Department of Medical Assistance Services (DMAS) intends to modify its reimbursement plan for durable medical equipments pursuant to the Department’s authority under Title XIX of the Social Security Act. This notice is intended to satisfy the requirements of § 1902(a)(13) of the Social Security Act, 42 U.S.C. § 1396a(a)(13). The changes contained in this public notice are occurring in response to Chapter 4, Item 326 BBB of the 2004 Acts of the Assembly. This mandate directed DMAS to “amend the State Plan for Medical Assistance to set the rate for durable medical equipment at the Durable Medical Equipment Regional Carrier (DMERC) reimbursement level for those items that have a national Healthcare Common Procedure Code System (HCPCS) code.”
Reimbursement for durable medical equipment (DME) shall be determined as follows:
(i) For those items that have a national Healthcare Common Procedure Coding System (HCPCS) code, the rate for durable medical equipment shall be set at the Durable Medical Equipment Regional Carrier (DMERC) reimbursement level;
(ii) For those items that do not have national HCPCS codes, the rate paid for all items of durable medical equipment except nutritional supplements shall be the lower of the state agency fee schedule that existed prior to July 1, 1996, less 4.5%, or the actual charge.
(iii) The rate paid for nutritional supplements shall be the lower of the state agency fee schedule or the actual charge.
There is no expected annual increase or decrease in expenditures for these changes to the reimbursement for durable medical equipment under this DMERC methodology.
A copy of this notice is available for public review from Bill Butler, Manager, Long Term Care Operations, DMAS, 600 Broad Street, Suite 1300, Richmond, VA 23219, and this notice is available for public review at www.townhall.state.va.us. Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Mr. Butler and such comments are available for review at the same address.