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
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 Durable Medical Equipment (DME) Services Updates
Pursuant to Chapter 874 of the 2010 Acts of Assembly Item 297 UUU and WWW is modifying its reimbursement for durable medical equipment as follows:
a. Reduce reimbursement for DME that has a Durable Medical Equipment Regional Carrier (DMERC) rate from 100 percent of Medicare reimbursement to 90 percent of the Medicare level.
b. Reduce fee schedule rates for DME and supplies by category-specific amounts as recommended in the November 1, 2009, Report on Durable Medical Equipment Reimbursement to the Senate Finance and House Appropriations Committees. The Department of Medical Assistance Services shall also modify the pricing of incontinence supplies from case to item, which is the industry standard.
c. Establish rates for additional procedure codes where benchmark rates are available.
d. Reimburse at cost plus 30 percent for any item not on the fee schedule. Cost shall be no more than the net manufacturer’s charge to the provider, less shipping and handling.
e. Determine alternate pricing for any code that does not have a rate.
f. Limit service day reimbursement to intravenous and oxygen therapy equipment.
g. Modify the limit on incontinence supplies prior to requiring prior authorization.
DMAS is making these changes in response to specific directives received from the Virginia General Assembly. The annual aggregate decrease in expenditures is expected to be (for FY 2011) $6,679,509 ($3,832,075 for the proposed rate changes; $2,847,434 for the diaper limit proposed change). The specific regulatory changes will be posted on the Virginia Regulatory Town Hall under the Secretary of Health and Human Resources list for the Department of Medical Assistance Services.
Comments may be directed to Elizabeth Flaherty, R.N.
Healthcare Compliance Specialist
Division of Long Term Care, DMAS
600 East Broad Street, Suite 1300
Richmond, VA 23219
The Department is submitting an emergency regulation, pursuant to the Code of Virginia §2.2-4011, to the Governor for approval. Pending the Governor’s approval of the emergency regulation, DMAS will provide copies of said emergency regulations to all requesters, along with proposed provider-specific reimbursement rates. Please forward your written request to the Regulatory Coordinator, DMAS, 600 East Broad Street, Richmond, VA, 23219. Further information is also available at www.townhall.state.va.us