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 – Long-Term Care (12 VAC 30-90). 

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-Long-Term Care (12 VAC 30-90)

In accordance with the General Assembly, DMAS revised the state plan in 2022 and 2023 to establish a unified, value-based purchasing (VBP) program that includes enhanced funding for nursing facilities that meet or exceed performance and/or improvement thresholds as developed, reported, and consistently measured by DMAS in cooperation with participating facilities.  During the first year of the program, half of the available funding was distributed to participating nursing facilities to be invested in functions, staffing, and other efforts necessary to build their capacity to enhance the quality of care furnished to Medicaid members. This funding was administered as a Medicaid rate add-on. The remaining funding was allocated based on performance criteria as designated under the nursing facility VBP program.  During the second year of the program, the amount of funding devoted to nursing facility quality of care investments was 25 percent of available funding.

In accordance with Item 288.QQQ.2.b of the 2024 Appropriations Act, DMAS is amending the state plan for the third year of the nursing facility VBP program.  During the third year of the program, 100 percent of payments will be disbursed to participating nursing facilities that qualify for the enhanced funding based on performance criteria. 

There is no expected increase or decrease in annual aggregate fee-for-service expenditures in federal fiscal year 2024. The expected increase in annual aggregate fee-for-service expenditures is $911,586 in state general funds and $948,414 in federal funds in federal fiscal year 2025.