Submitted Online (www.townhall.com) and Sent Via Email (Emily.McClellan@dmas.virginia.gov)

September 10, 2020

Emily McClellan

Virginia Department of Medical Assistance Services

600 E. Broad St., Suite 1300

Richmond, VA 23219

Re:       Virginia Hospital & Healthcare Association

Public Comment on Physician Manual Chapters IV, V

Virginia Hospital & Healthcare Association (“VHHA”) appreciates the opportunity to submit comments to the Virginia Department of Medical Assistance Services (“DMAS”) in response to its General Notice regarding draft Physician Manual Chapters IV, V posted on August 11, 2020.  The draft changes to Chapters IV, V relate to implementation of reimbursement changes directed by Item 313.AAAAA of HB30 (the “Budget Bill”), which alters Medicaid reimbursements for certain emergency department (“ED”) claims (the “Reimbursement Change”).

On June 19, 2020, VHHA submitted public comment in response to the DMAS Notice of Intent to Amend the Virginia State Plan for Medical Assistance posted on May 20, 2020, for the purpose of implementing the Reimbursement Change.  In its public comment in response to that notice, VHHA expressed its opposition to the Reimbursement Change and related State Plan Amendment.  Because this General Notice relates to the same subject matter as the proposed State Plan Amendment, VHHA is opposed to the draft changes to Physician Manual Chapters IV, V for the same reasons stated in our public comment on June 19, 2020.   

For your reference, please find enclosed a copy of the public comment submitted on June 19, 2020, expressing our opposition to the Reimbursement Change. 

https://townhall.virginia.gov/l/viewcomments.cfm?commentid=80911

To summarize the reasons for our opposition as it relates to the Reimbursement Change and the draft Physician Manual Chapters IV, V:

• DMAS’ planned implementation of the Reimbursement Change will significantly undermine our partnership with the state on COVID-19 response and Medicaid Expansion and further erode hospitals’ ability to provide access to essential health care for Medicaid enrollees.  Furthermore, the proposed reimbursement changes stand to disproportionately impact facilities that treat a high percentage of Medicaid patients, penalizing them for providing access to care for medically underserved and vulnerable patient populations who do not have adequate alternatives, further contributing to inequity and historical disparities in access to care. 
• Aside from these critical access and health equity concerns, implementation of Item 313.AAAAA will violate federal Medicaid regulations, conflict with the well-established “prudent layperson” (“PLP”) standard, raise constitutional concerns, and ultimately fail to reduce avoidable and unnecessary ED utilization.  For these reasons, as set forth in more detail below, VHHA opposes DMAS’ proposed reimbursement changes.

For all of the reasons stated in our June 19, 2020, public comment and restated herein, VHHA is opposed to the draft Physician Manual Chapters IV, V.  Furthermore, to our knowledge the State Plan Amendments for the Reimbursement Change have not yet been approved by the Centers for Medicare & Medicaid Services.  Accordingly, it may be premature to amend the Physician Manual at this time. 

Thank you again for this opportunity to comment.  If you have any questions or require clarifications of our comments, please feel free to contact me at brawlings@vhha.com.

Sincerely,

R. Brent Rawlings
Senior Vice President & General Counsel

Enclosure