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

General Notice
Notice of Intent to Amend - 2010 Appropriations Act Mandated Reimbursement Changes
Date Posted: 5/27/2010
Expiration Date: 7/15/2010
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 intends to implement a number of changes in reimbursement methodology July 1, 2010, pursuant to Item 297 of Chapter 874 of the 2010 Appropriations Act.  These are cost savings measures arising from the need for budget reductions statewide.  If Congress extends through June 30, 2011 the increased federal funds matching rates, which otherwise will end December 31, 2010, the 2010 Appropriation Act directs DMAS to not implement some of these changes.

 

Reimbursement Changes Affecting Hospitals (12 VAC 30-70)

12VAC30-70-50 is being amended to eliminate the inflation adjustment for long-stay hospitals for State Fiscal Year (SFY) 2011 and SFY 2012 and to freeze ceilings in SFY 2011 and SFY 2012 at the same level as the ceilings for long stay hospitals with Fiscal Year Ends (FYEs) of June 30, 2010. This change is mandated by Item 297.AAA of the Appropriation Act. 

 

12VAC30-70-351 is being amended to rebase hospital diagnosis-related group (DRG) weights, case rates, psychiatric and rehabilitation per diem rates except that 2008 base year costs shall only be increased 2.58 percent in SFY 2011.  No inflation adjustment shall be applied to hospital operating rates in SFY 2012.  This change is mandated in Item 297.BBB.1.a of the Appropriation Act.

 

12VAC30-70-221, 12VAC30-70-301, 12VAC30-70-391, are being amended to change the inpatient hospital Medicaid utilization percent from 15 to 14 percent to determine Disproportionate Share Hospital (DSH) eligibility. DSH reimbursement is to be rebased for all hospitals with the final calculation being reduced by a uniform percentage so that SFY 2011


expenditures do not exceed SFY 2010 expenditures. No inflation adjustment shall be applied to hospital DSH payments in SFY 2012.  This change is mandated by Item 297.BBB.1.b of the Appropriation Act.

 

12VAC30-70-351 is being amended to eliminate inflation for graduate medical education per resident amounts in SFY 2011 and SFY 2012 as directed by Item 297.BBB.1.c of the Appropriation Act.

 

12VAC30-70-351 and 12VAC30-70-391 are being amended to eliminate rebasing in SFY 2011 and inflation in SFY 2011 and SFY 2012 for freestanding psychiatric hospital facilities as directed in Item 297.CCC of the Appropriation Act.

 

12VAC30-70-291 is being amended to exclude certain out-of-state hospitals from receiving indirect medical education payments and 12VAC30-70-301 is being amended to reduce DSH payments to certain out-of-state hospitals.  These changes are mandated in Item 297.TTT of the Appropriation Act.

 

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

12VAC30-80-180 is being amended to eliminate the SFY 2011 and SFY 2012 inflation adjustments for home health agencies. This change is mandated in Item 297.FFF of the Appropriation Act.

 

12VAC30-80-190 is being amended to reduce rates for procedure codes determined under Resource Based Relative Value System (RBRVS) (these codes are billed by physicians and other practitioners) by 3 percent in SFY 2011. In SFY 2012, rates will be reduced by 4 percent from what they would have been without the 3 percent reduction (an additional 1 percent reduction).  This change is mandated in Item 297 CCCC of the Appropriation Act.

 

12VAC30-80-200 is being amended to eliminate the SFY 2011 and SFY 2012 inflation adjustments for outpatient rehabilitation agencies as mandated by Item 297.GGG of Chap. 874 of the Appropriation Act. 

 

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

12VAC30-90-41 is being amended to eliminate rebasing in SFY 2011 and inflation in SFY 2011 and SFY 2012 as directed by Item 306.DDD1.a of the Appropriations Act  Nursing facility and specialized care ceilings shall be frozen at the same level as providers with fiscal year ends of June 30, 2010.

 

The American Recovery and Reinvestment Act (P.L. 111-5)

In addition to the above-described changes, the 2010 General Assembly also required DMAS to implement on July 1, 2010 the changes listed below.  These changes, however, are dependent upon whether additional federal stimulus money will be available to state Medicaid programs.  These actions will not be implemented if FMAP under ARRA is extended to June 30, 2011.

 

Reimbursement Changes Affecting Hospitals (12 VAC 30-70)

Eliminate the efficiency incentive for long-stay hospitals. (Item 297.AAA).

 

Reduce inpatient capital reimbursement from 75 to 72 percent of cost and 71 percent in SFY 2012 with corresponding changes for Type One hospitals and Virginia hospitals with Medicaid utilization greater than 50 percent. (Item 297.HHHH).

 

Reduce the hospital adjustment factor from 78 to 75 percent for acute and rehab services and from 84 to 81 percent for psychiatric services and 74 percent and 80 percent respectively in SFY 2012. Corresponding changes for Type One hospitals. (Item 297.AAAA).

 

Reduce outpatient hospital reimbursement from 80 to 77 percent of cost and to 76 percent in SFY 2012. Corresponding changes for Type One hospitals. (Item 297.BBBB).

 

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

12 VAC 30-80-40 (Fee-for-service providers: pharmacy) is being amended per Item 297 SSS of Chap. 874 to decrease the maximum reimbursement for pharmaceutical products to the Average Wholesale Price minus 13.1 percent, effective July 1, 2010.    

 

Reduce physician rates by three percent with an additional one percent reduction in SFY 2012. (Item 297.CCCC).

 

Reduce dental fees by three percent with an additional one percent reduction in SFY 2012. (Item 297.DDDD).

 

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

Reduce nursing facility operating rates by three percent in SFY 2011 and 2012. (Item 297.DDD.1b).

 

Reduce nursing facility capital rental rate floor from 9 to 8.75 percent in SFY 2011 and to 8.5 percent in SFY 2012. (Item 297.DDD.1c).

 

 

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: William Lessard  / Provider Reimbursement Division
Address: 600 East Broad Street
Richmond, 23219
Email Address: William.Lessard@dmas.virginia.gov
Telephone: (804)225-4593    FAX: (804)371-8892    TDD: ()-