COMMONWEALTH OF VIRGINIA
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Notice of Intent to Modify Medicaid Co-Pay Structure: Increased Cost-Sharing Measures
Notice is hereby given that the Department of Medical Assistance Services (DMAS) intends to modify its Medicaid co-payment structure pursuant to the Department’s authority under Title XIX of the Social Security Act. 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). The changes contained in this public notice are occurring in response to Chapter 4 of the 2004 Acts of the Assembly, Item 326 EEE directing DMAS to increase recipient cost-sharing measures to meet target savings.
As directed by the Act, on October 1, 2004, DMAS reported on a plan to increase cost sharing requirements that would meet the savings targets. The plan proposed to increase the amount of patient co-payments on certain services where cost sharing already exists and to initiate co-payments on certain services that do not currently have cost sharing requirements. The proposed Medicaid co-payment amounts are permissible under Federal regulations, which stipulate that the State may require nominal co-payments (i.e., $0.50 - $3.00) based on the typical State payment for the service. The proposed change will increase the co-payments for clinic visits and eye exams from $1.00 to $2.00, and will apply to both medically and categorically needy Medicaid recipients. Providers of these services are responsible to collect co-payment, which amounts are withheld from their reimbursement.
A copy of this notice is available for public review from Tom Edicola, Director, Program Operations Division, 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. Edicola and such comments are available for review at the same address.