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 May 31, 2019

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 Services (12 VAC 30-70) and Methods and Standards for Establishing Payment Rates — Other Types of Care (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.com), on the General Notices page, found at:  https://townhall.virginia.gov/L/generalnotice.cfm

Methods & Standards for Establishing Payment Rates – Inpatient Care (12 VAC 30-70)

1. The state plan is being revised to increase reimbursement for Critical Access Hospitals by using an adjustment factor or percent of cost reimbursement of 100% for inpatient operating and capital rates and outpatient rates, effective July 1, 2019.

The expected increase in annual aggregate expenditures is $4,737,031 in fiscal year 2020.

2.  The state plan is being revised to fund supplemental payments for the second and third years of graduate medical education for 13 funded slots for residents who began their residencies in July 2018 and the first year of graduate medical education of 20 funded slots for residencies in July 2019, and two one-year post graduate fellowships in July 2019.

The expected increase in annual aggregate expenditures is $4,600,000 in fiscal year 2020.

3.  The state plan is being revised to clarify payment rules for new nursing homes or renovations that qualify for mid-year rate adjustments, effective July 1, 2019, to include the following:

a. For any facility whose Fair Rental Value report has less than 12 months of experience, the department shall develop an occupancy schedule that represents average statewide occupancy by month of operation for use in calculating the per diem rate in lieu of a minimum occupancy requirement or actual occupancy.

b. Any new beds or renovations placed in service between the reporting year and the rate year shall be treated as a mid-year rate adjustment. No new rate will be made after April 30. Rate updates that fall between May 1 and June 30 shall be effective July 1 of the same year.

c. The department shall annualize real estate taxes, property taxes and property insurance costs that do not represent a full year's cost.

d. Costs shall be based on currently available documentation at the time but are subject to audit. The department may use any reasonable method to estimate costs for which there is inadequate documentation. Any adjustments based on subsequent documentation or audit for a current rate year shall be applied beginning with the next rate year.

e. The department shall have 15 days from the date of the provider's submission to determine if the filing is complete for purposes of setting a rate for a new or renovated facility. The facility shall have 15 days from the date the filing is deemed incomplete to submit the required information. The deadline for setting the rate shall be extended for 30 days after the filing is deemed complete.

f. Providers may propose a phased renovation subject to approval by the department. The phased renovation may include reductions to available beds. Any modifications to the proposed renovation are also subject to approval by the department.

There is no expected increase or decrease in annual aggregate expenditures in fiscal year 2020.

Methods & Standards for Establishing Payment Rates-Other Types of Care (12 VAC 30-80)

1.  The state plan is being revised, effective July 1, 2019, to increase the practitioner rates for adult primary care services by five percent and rates for Emergency Department services by one percent to reflect the equivalent of 70 percent of the 2018 Medicare rates.

The expected increase in annual aggregate expenditures is $15,245,693 in fiscal year 2020.

2.  The state plan is being revised, effective July 1, 2019, to create a separate service category for psychiatric services and to increase practitioner rates for psychiatric services by 21 percent to reflect the equivalent of 100 percent of the 2018 Medicare rates.

The expected increase in annual aggregate expenditures is $7,206,457 in fiscal year 2020.

3.  The state plan is being revised, effective July 1, 2019, to increase the telehealth originating site facility fee to 100 percent of the Medicare rate and to reflect changes annually based on any changes in the Medicare rate. DMAS shall exempt Federally Qualified Health Centers and Rural Health Centers from this reimbursement change.

The expected increase in annual aggregate expenditures is $50,744 in fiscal year 2020.

4.  The state plan is being revised, effective July 1, 2019, to modify reimbursement for Hospice services provided to patients residing in facilities to include at least 100 percent of the relevant Medicaid facility rate for that individual.

The expected increase in annual aggregate expenditures is $894,440 in fiscal year 2020.

5.  The state plan is being revised, effective July 1, 2019, to increase the rates for personal care in Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program by two percent.

The expected increase in annual aggregate expenditures is $9,933,601 in fiscal year 2020.