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 College of Emergency Physicians’ Public Comment on Physician Manual Chapters IV, V

The Virginia College of Emergency Physicians (VACEP) 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 reflect the implementation of reimbursement changes directed by Item 313.AAAAA of HB30, which alters Medicaid reimbursements for level 2, 3 and 4 emergency department claims solely if they are on a “preventable” ER visit list. 

On June 18, 2020, VACEP 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 automatic downcoding.  In our public comments, we clearly expressed our opposition to the implementation of the ER Utilization program.  Because this General Notice relates to the same subject matter as the proposed State Plan Amendment, VACEP is opposed to the draft changes to Physician Manual Chapters IV, V for the same reasons stated in our public comment on June 18, 2020.   

For your reference, please find enclosed a copy of the public comment submitted on June 18, 2020, expressing our opposition to the implementation of the ER Utilization program.  To summarize, we believe the ER Utilization program to be inconsistent with the federal and state prudent layperson standard and CMS policy against paying for emergency care based solely on a diagnosis list.

To that end, we therefore oppose amending the Physician Manual Chapters IV, V.  Furthermore, it is our understanding that DMAs has yet to even submit their State Plan Amendments for the ER Utilization program to CMS for approval.  Therefore, we believe it to 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 us.  

Sincerely,  

K. Scott Hickey, MD, FACEP

President