Virginia Regulatory Town Hall View Chapter

Department of Medical Assistance Services

Board of Medical Assistance Services

Methods and Standards for Establishing Payment Rates for Long-Term Care [12 VAC 30 ‑ 90]

Chapter Information

Description	This chapter contains the reimbursement methodology for long-term care services (nursing facilities).
State Authority	COV 32.1-325 et seq .
Federal Authority	Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Text of Regulation	Link to Virginia Administrative Code
Goals of Regulation	None entered
Meetings

Contact Information

Name / Title:	Emily McClellan / Regulatory Supervisor
Address:	Policy Division, DMAS 600 E. Broad Street, Suite 1300 Richmond, VA 23219
Email Address:	Emily.McClellan@DMAS.Virginia.gov
Telephone:	(804)371-4300 FAX: (804)786-1680 TDD: ()-

Action Title	Latest Stage	Status
Current Actions
None

Action Title	Latest Stage	Status
Past Actions
2020 Provider Reimbursement Changes	Final	Stage complete. This regulation became effective on 12/23/2020.
Fair Rental Value for New and Renovated Nursing Facilities	Fast-Track	Stage complete. This regulation became effective on 04/15/2021.
2018 Institutional Provider Reimbursement Updates - Final Exempt	Final	Stage complete. This regulation became effective on 10/02/2019.
Reimbursement Changes Affecting Long Term Care	Fast-Track	Stage complete. This regulation became effective on 09/20/2018.
2016 and 2017 Provider Reimbursement Changes	Final	Stage complete. This regulation became effective on 02/21/2018.
Institutional Provider Reimbursement Changes	Fast-Track	Stage complete. This regulation became effective on 12/01/2016.
Supplemental Payments for Various Provider Types (Hospitals, EVMS Physicians, NFs)	Fast-Track	Stage complete. This regulation became effective on 11/17/2016.
NF Price-Based Reimbursement	Fast-Track	Stage complete. This regulation became effective on 02/11/2016.
2013 Reimbursement Changes	Final	Stage complete. This regulation became effective on 06/18/2014.
ICF/IID ceiling; cost report submission; credit balance reporting	Fast-Track	Stage complete. This regulation became effective on 01/01/2016.
Supplemental Payments for Institutional/Non-Institutional Providers	Fast-Track	Stage complete. This regulation became effective on 02/13/2015.
2012 Reimbursement Methodology Changes	Final	Stage complete. This regulation became effective on 08/14/2013.
2011 Budget Reimbursement Changes	Final	Stage complete. This regulation became effective on 07/01/2011.
2011 Technical Corrections for Reimbursment Regulations	Final	Stage complete. This regulation became effective on 04/27/2011.
2010 Reimbursement and Provider Termination Changes	Final	Stage complete. This regulation became effective on 07/01/2010.
2009 Hospital, Home Health, and Nursing Facility Reimbursement Changes	Final	Stage complete. This regulation became effective on 03/17/2010.
2008 Reimbursement Changes	Final	Stage complete. This regulation became effective on 10/15/2008.
Simplify Hospital and Specialized Care Reimbursement	Fast-Track	Stage complete. This regulation became effective on 11/27/2008.
2007 Reimbursement Changes	Final	Stage complete. This regulation became effective on 07/01/2007.
Increase Reimbursement for Hospitals, Certain Physicians and Nursing Facilities	Fast-Track	Stage complete. This regulation became effective on 08/25/2007.
Reimbursement for NF Specialized Care Ancillary Services	Final	Stage complete. This regulation became effective on 04/19/2007.
Modifications to Supplemental Payment Methods for Medicaid Public Providers.	Final	Stage complete. This regulation became effective on 08/23/2006.
Additional NF Reimbursement for Stage IV Pressure Ulcers	Final	Stage complete. This regulation became effective on 08/09/2006.
Increase in Nursing Home Rates	Fast-Track	Stage complete. This regulation became effective on 07/01/2005.
Transition to New Capital Paym Method (R)	Final	Stage complete. This regulation became effective on 10/04/2004.
Discontinue Adult Specialized Care Services Reimbursement	Final	Stage complete. This regulation became effective on 07/01/2004.
Limit Indirect and Direct Care Inflation for FY 2004	Emergency	Stage complete. Emergency regulation expired on 06/30/2004.
Supplemental Payments for Inpatient and Outpatient Services	Final	Stage complete. This regulation became effective on 01/28/2004.
NHPS: Revise Indirect Cost Formula	Final	Stage complete. This regulation became effective on 07/01/2003.
Nursing Home Payment System PIRS Methodology	NOIRA	Stage withdrawn on 07/02/2002 before the Governor's office completed its review.
Nursing Home Payment System: Resource Utilization Groups (RUGS)	Final	Stage complete. This regulation became effective on 07/01/2002.
Provider Appeals	Final	Stage complete. This regulation became effective on 07/04/2001.
2000 Nursing Home Payment System	Final	Stage complete. This regulation became effective on 07/01/2001.
Intergovernmental Transfers (IGT)	NOIRA	Stage withdrawn on 09/04/2001 prior to submission to DPB.
Nursing Facility Reimbursement System	NOIRA	Stage withdrawn on 07/24/2000 after the Governor's office completed its review.
Nursing Home Payment System: Increase Payments for Increased Certified Nurse Aide Salaries and Other Direct Costs	Emergency	Stage withdrawn on 08/13/1999 prior to publication in The Virginia Register.

Action Title	Latest Stage	Status
Withdrawn Actions
CH 0080 Reimbursement - Hospitals	Fast-Track	Stage withdrawn on 03/10/2017 prior to submitting for AG review.
Reimbursement Changes Affecting Long Term Care	Fast-Track	Stage withdrawn on 09/22/2017 prior to submitting for AG review.
2016 Institutional Provider Reimbursement	Fast-Track	Stage withdrawn on 08/08/2017 before Attorney General's office completed its review.
2010 Reimbursment Changes (Stimulus)	Final	Stage withdrawn on 11/12/2013 before submission to the Registrar.
Reimbursement for NF Specialized Care Ancillary Services	Proposed	Stage withdrawn on 06/06/2007 before DPB completed its review.
NF Credit Balance Reporting	NOIRA	Stage withdrawn on 04/12/2004 after the comment period had ended.