Notice of Intent to Increase Payments to
Nursing Facilities for Residents Requiring Specialized Treatment Beds
Notice is hereby given that the Department of Medical Assistance Services (DMAS) intends to modify its reimbursement plan for nursing facilities 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 the cost of providing specialized treatment beds for nursing facility residents who have Stage IV pressure ulcers. This payment methodology change is resulting from a specific mandate to the Department in the 2004 Acts of the Assembly, Chapter 4, Item 326 RR.
DMAS was directed to modify its reimbursement methodology for nursing facilities to provide an additional $10 per day reimbursement for residents who require specialized treatment beds due to their having at least one treatable stage IV pressure ulcer. This additional $10 per day to be added to these NFs’ per diem rates is intended to defray their costs of providing specialized treatment beds to their residents with stage IV pressure ulcers. To qualify for this additional payment, NFs must obtain the required prior authorization for each resident who requires this additional service.
DMAS estimates that the annual total fund cost would be approximately $1.5 million. This estimate assumes that each resident who requires this additional service will need it for an average of 90 days.
A copy of this notice is available for public review from Diana Thorpe, Director, Division of LTC and Quality Assurance, DMAS, 600 Broad Street, Suite 1300, Richmond, VA 23219, and this notice is available for public review at any local public library. Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Thorpe and such comments are available for review at the same address.