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; Methods and Standards for Establishing Payment Rates—Other Types of Care; and Methods and Standards for Establishing Payment Rates—Long Term Care. The Department intends to implement a number of changes in reimbursement methodology July 1, 2009, pursuant to the Appropriations Act (Chap. 781) from the 2009 General Assembly. These are cost savings measures arising from the need for budget reductions statewide. These changes are being made pursuant to the Department’s authority under Title XIX of the Social Security Act, and are as follows:
Reimbursement Changes Affecting Hospitals (12 VAC 30-70)
-- Per Item 306 MMM of Chap. 781, operating rates for all hospitals will not be increased for inflation. This action will lead to a total cost savings of $44.3 Million in state fiscal year 2010.
-- Per Item 306 GGG of Chap. 781, capital reimbursement for all hospitals will be reduced from 80% of cost to 75% of cost. This action will lead to a total cost savings of $8.7 Million in state fiscal year 2010.
-- Per Item 306 BBB of Chap. 781, reimbursement for long-stay hospitals will be modified to eliminate the incentive plan and to remove the additional 2% added to inflation for the escalator used to increase ceilings and inflate costs per day. This action will lead to a total cost savings of $2.0 Million in state fiscal year 2010.
-- Per Item 306 FFF of Chap. 781, operating rates for freestanding psychiatric hospitals will be rebased to 100% of 2005 costs inflated forward (but subject to other limitations on operating rates including no inflation in FY10). This action will lead to a total cost savings of $1.5 Million in state fiscal year 2010.
Reimbursement Changes Affecting Other Providers (12 VAC 30-80)
-- Per Item 306 III of Chap. 781, home health agencies will lose 50% of the inflation increase they received on January 1, 2009 and will not receive another inflation increase until July 1, 2010. This action will lead to a total cost savings of $0.6 Million in state fiscal year 2010.
-- Per Item 306 XX of Chap. 781, reimbursement for outpatient rehabilitation agencies will be changed from prospective cost-based provider specific rates subject to a ceiling to a statewide fee schedule. This change will achieve savings of $0.4 Million equivalent to not receiving an inflation adjustment.
Pharmacy Dispensing Fee Reduction Per Item 306 WW of Chap. 781, the Agency is amending 12 VAC 30-80-40 (Fee-for-service providers: pharmacy) to reduce the dispensing fee for both brand name and generic drugs from $4.00 to $3.75, effective July 1, 2009. This action will lead to a total cost savings of $925,332 in state fiscal year 2010.
Reimbursement Changes Affecting Nursing Facilities (12 VAC 30-90)
-- Per Item 306 VV of Chap. 781, operating rates for nursing facilities shall not be reduced by 1.329%. This action will lead to a total cost increase of $11.7 Million in state fiscal year 2010.
-- Per Item 306 NNN of Chap. 781, operating rates and ceilings for nursing facilities and specialized care facilities will not be increased for inflation. This action will lead to a total cost savings of $28.4 Million in state fiscal year 2010.
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.
