Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services
 
chapter
Methods and Standards for Establishing Payment Rates for Long-Term Care [12 VAC 30 ‑ 90]
Guidance Documents
Chapter Information
Description This chapter contains the reimbursement methodology for long-term care services (nursing facilities).
State Authority COV 32.1-325 et seq .
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Exempt from APA No, changes to this chapter are subject to the Administrative Process Act.
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings

Contact Information
Name / Title: Emily McClellan  / Regulatory Supervisor
Address: Policy Division, DMAS
600 E. Broad Street, Suite 1300
Richmond, VA 23219
Email Address: Emily.McClellan@DMAS.Virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: ()-
Current Actions
Action Title Latest Stage Status
Intergovernmental Transfers (IGT) -

Past Actions
Action Title Latest Stage Status
2020 Provider Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 12/23/2020.
Fair Rental Value for New and Renovated Nursing Facilities Fast-Track Stage complete. This regulation became effective on 04/15/2021.
2018 Institutional Provider Reimbursement Updates - Final Exempt
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 10/02/2019.
Reimbursement Changes Affecting Long Term Care Fast-Track Stage complete. This regulation became effective on 09/20/2018.
2016 and 2017 Provider Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 02/21/2018.
Institutional Provider Reimbursement Changes Fast-Track Stage complete. This regulation became effective on 12/01/2016.
Supplemental Payments for Various Provider Types (Hospitals, EVMS Physicians, NFs) Fast-Track Stage complete. This regulation became effective on 11/17/2016.
NF Price-Based Reimbursement Fast-Track Stage complete. This regulation became effective on 02/11/2016.
2013 Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 06/18/2014.
ICF/IID ceiling; cost report submission; credit balance reporting Fast-Track Stage complete. This regulation became effective on 01/01/2016.
Supplemental Payments for Institutional/Non-Institutional Providers Fast-Track Stage complete. This regulation became effective on 02/13/2015.
2012 Reimbursement Methodology Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/14/2013.
2011 Budget Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2011.
2011 Technical Corrections for Reimbursment Regulations
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/27/2011.
2010 Reimbursement and Provider Termination Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2010.
2009 Hospital, Home Health, and Nursing Facility Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 03/17/2010.
2008 Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 10/15/2008.
Simplify Hospital and Specialized Care Reimbursement Fast-Track Stage complete. This regulation became effective on 11/27/2008.
2007 Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2007.
Increase Reimbursement for Hospitals, Certain Physicians and Nursing Facilities Fast-Track Stage complete. This regulation became effective on 08/25/2007.
Reimbursement for NF Specialized Care Ancillary Services Final Stage complete. This regulation became effective on 04/19/2007.
Modifications to Supplemental Payment Methods for Medicaid Public Providers. Final Stage complete. This regulation became effective on 08/23/2006.
Additional NF Reimbursement for Stage IV Pressure Ulcers Final Stage complete. This regulation became effective on 08/09/2006.
Increase in Nursing Home Rates Fast-Track Stage complete. This regulation became effective on 07/01/2005.
Transition to New Capital Paym Method (R) Final Stage complete. This regulation became effective on 10/04/2004.
Discontinue Adult Specialized Care Services Reimbursement Final Stage complete. This regulation became effective on 07/01/2004.
Limit Indirect and Direct Care Inflation for FY 2004 Emergency Stage complete. Emergency regulation expired on 06/30/2004.
Supplemental Payments for Inpatient and Outpatient Services Final Stage complete. This regulation became effective on 01/28/2004.
NHPS: Revise Indirect Cost Formula Final Stage complete. This regulation became effective on 07/01/2003.
Nursing Home Payment System PIRS Methodology NOIRA Stage withdrawn on 07/02/2002 before the Governor's office completed its review.
Nursing Home Payment System: Resource Utilization Groups (RUGS) Final Stage complete. This regulation became effective on 07/01/2002.
Provider Appeals Final Stage complete. This regulation became effective on 07/04/2001.
2000 Nursing Home Payment System Final Stage complete. This regulation became effective on 07/01/2001.
Nursing Facility Reimbursement System NOIRA Stage withdrawn on 07/24/2000 after the Governor's office completed its review.
Nursing Home Payment System: Increase Payments for Increased Certified Nurse Aide Salaries and Other Direct Costs Emergency Stage withdrawn on 08/13/1999 prior to publication in The Virginia Register.

Withdrawn Actions
Action Title Latest Stage Status
CH 0080 Reimbursement - Hospitals
Reimbursement Changes Affecting Long Term Care
2016 Institutional Provider Reimbursement
2010 Reimbursment Changes (Stimulus)
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage withdrawn on 11/12/2013 before submission to the Registrar.
Reimbursement for NF Specialized Care Ancillary Services Proposed Stage withdrawn on 06/06/2007 before DPB completed its review.
NF Credit Balance Reporting NOIRA Stage withdrawn on 04/12/2004 after the comment period had ended.