Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services

General Notice
2013 Provider Reimbursement Changes and EAPG Methodology
Date Posted: 8/14/2013
Expiration Date: 9/30/2013
Submitted to Registrar for publication: YES
No comment forum defined for this notice.

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

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—Inpatient Hospital Services (12 VAC 30-70); Methods and Standards for Establishing Payment Rates—Other Types of Care (12 VAC 30-80); and Methods and Standards for Establishing Payment Rates—Long Term Care (12 VAC 30-90).  The Department is implementing a number of changes in reimbursement methodology on or after July 1, 2013, pursuant to Item 307 of the 2013 Appropriation Act.

 Reimbursement Changes Affecting Hospitals (12 VAC 30-70)

12VAC30-70-301 is being amended to:

Maintain DSH payments in SFY 2014 at the SFY 2013 level.  This change is mandated by Item 307.DDDD of the Appropriation Act.

 ($21,746,159) GF, ($21,746,159) NGF, ($43,492,318) TF

 

12VAC30-70-291 is being amended to:

Increase Indirect Medical Education payments for freestanding children’s hospitals. This change is mandated by Item 307.OOOO of the Appropriation Act.

 $0 GF, $0 NGF, $0 TF

 Reimbursement Changes Affecting Other Providers (12 VAC 30-80)

12VAC30-80-110 is being amended to specify reimbursement requirements for targeted case management for high-risk pregnant women and infants up to age two, for community mental health and mental retardation services, and for individuals who have applied for or are participating in the Individual and Family Developmental Disability Support Waiver program to come into compliance with federal requirements.

 $0 GF, $0 NGF, $0 TF

 

12VAC30-80-20 is being amended and 12VAC30-80-36 is being created to implement Enhanced Ambulatory Patient Group (EAPG) reimbursement for outpatient hospital services effective October 1, 2013.  The implementation shall be budget neutral.  The authority to implement the EAPG reimbursement methodology for outpatient hospital services is granted by Item 307.OOOO of the Appropriation Act.

 $0 GF, $0 NGF, $0 TF

 Reimbursement Changes Affecting Nursing Facilities (12 VAC 30-90)

12VAC30-90-36 is being amended to modify minimum occupancy requirement for nursing facilities from 90 percent to 88 percent. This change is mandated by Item 307.CCCC of the Appropriation Act.

 $916,624 GF, $916,624 NGF, $1,833,248 TF

 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 William Lessard, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.com).  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Mr. Lessard and such comments are available for review at the same address.


Contact Information
Name / Title: Brian McCormick  / Regulatory Supervisor
Address: 600 E. Broad St., Suite 1300
Richmond, 23219
Email Address: Brian.McCormick@dmas.virginia.gov
Telephone: (804)371-8856    FAX: (804)786-1680    TDD: (800)343-0634