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 June 21, 2018

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) and Methods and Standards for Establishing Payment Rates – Other Types of Services (12 VAC 30-80).

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 Elizabeth Jones, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, or via e-mail at:  Beth.Jones@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 Ms. Jones 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 (www.townhall.virginia.gov), on the General Notices page, found at:  https://townhall.virginia.gov/L/generalnotice.cfm

1.  Graduate Medical Education (GME) Incentive Payments for new primary care and high need specialty residencies. The 2018 Acts of Assembly directs DMAS to provide supplemental payments to qualifying institutions for primary care and high-need specialty medical residencies. The supplemental payment for each qualifying residency slot shall be $100,000 annually minus any Medicare residency payment for which the sponsoring institution is eligible. Supplemental payments shall be made for up to four years for each qualifying resident. Payments shall be made quarterly following the same schedule used for other medical education payments.  The current state plan designates the number of residents for each institution for the first cohort (15 slots) beginning in July 2017.  Effective July 1, 2018, the department is amending the State Plan to make supplemental payments to the following sponsoring institutions for the specified number of primary care residencies for up to four years: Sentara Norfolk General (1 residency), Maryview Hospital (1 residency) and Carilion Medical Center (6 residencies). The department shall make supplemental payments to Carilion Medical Center for 2 psychiatry residencies and to Sentara Norfolk General for 1 OB/GYN residency, 2 psychiatric residencies, and 1 urology residency.

The expected increase in annual aggregate expenditures is $2,900,000 for state fiscal year 2019 and $2,900,000 for state fiscal year 2020.

2.  Eliminate Disproportionate Share Hospital payment eligibility and increase Indirect Medical Education payment for Children’s National Medical Center. Effective July 1, 2018, the Department of Medical Assistance Services is amending the State Plan for Medical Assistance to eliminate eligibility for DSH for Children’s National Medical Center, an out-of-state children’s hospital, increase the reimbursement for indirect medical education (IME) for Children’s National Medical center by the amount of DSH the hospital was eligible for in 2018 and reduce the Type Two DSH allotment by the same amount.

The expected change in annual aggregate expenditures is $0.

3.  Establish supplemental inpatient and outpatient payments for Chesapeake Regional Hospital.  The department is amending the State plan for Medical Assistance to implement a supplemental inpatient and outpatient payment for Chesapeake Regional Hospital. The payment is determined as the difference between reimbursement with rates using an adjustment factor of 100% and the provider’s current authorized reimbursement. The payment is subject to the inpatient and outpatient Upper Payment Limits for non-state government owned hospitals. The department shall include in its contracts with managed care organizations a minimum fee schedule for Chesapeake Regional Hospital consistent with rates using an adjustment factor of 100%. The department shall adjust capitation payments to Medicaid managed care organizations to fund this minimum fee schedule.

The expected increase in annual aggregate expenditures is $6,037,352 in state fiscal year 2019 and $6,218,472 in state fiscal year 2020.

4. Establish supplemental payments for nursing homes owned by Type One hospitals.  The department is amending the State plan to make supplemental payments for nursing homes owned by Type One hospitals (consisting of state-owned teaching hospitals) as provided in the State Plan for Medical Assistance Services. The total supplemental payment shall be based on the difference between the Upper Payment Limit of 42 CFR § 447.272 as approved by CMS and all other Medicaid payments subject to such limit made to such nursing homes.  The department shall include in its contracts with managed care organizations a minimum fee schedule for nursing homes owned by Type One hospitals consistent with the State Plan Amendment. The department shall adjust capitation payments to Medicaid managed care organizations to fund this minimum fee schedule.

The expected increase in annual aggregate expenditures is $5,205,503 in state fiscal year 2019.