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Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
chapter
Methods and Standards for Establishing Payment Rates; in-Patient Hospital Care [12 VAC 30 ‑ 70]
 
Guidance Documents
Chapter Information
Description This chapter contains the reimbursement methodology for inpatient hospital services.
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: ()-
Current Actions
Action Title Latest Stage Status
None

Past Actions
Action Title Latest Stage Status
Fee For Service Supplemental Payments and Hospital Assessment Final Stage complete. This regulation became effective on 01/01/2025.
Hospital Readmissions and Emergency Room Visits
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/20/2021.
2020 Provider Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 12/23/2020.
2019 Provider Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/08/2020.
2018 Institutional Provider Reimbursement Updates - Fast Track Fast-Track Stage complete. This regulation became effective on 03/05/2020.
2018 Institutional Provider Reimbursement Updates - Final Exempt
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 10/02/2019.
Sunset Supplemental Payments Fast-Track Stage complete. This regulation became effective on 11/15/2018.
CH 0080 CHKD Hospital Inflation, FFS Providers, & Reimbursement Services on a Cost Basis
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/08/2018.
DSH Payments for Inpatient Psychiatric Hospitals Fast-Track Stage complete. This regulation became effective on 11/01/2018.
2016 and 2017 Provider Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 02/21/2018.
Institutions for Mental Disease Reimbursement Changes Final Stage complete. This regulation became effective on 03/08/2017.
Hospital DSH Changes Fast-Track Stage complete. This regulation became effective on 06/29/2017.
All Patient-Refined DRG Payment Methodology Fast-Track Stage complete. This regulation became effective on 02/25/2016.
Supplemental Payments for Various Provider Types (Hospitals, EVMS Physicians, NFs) Fast-Track Stage complete. This regulation became effective on 11/17/2016.
2013 Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 06/18/2014.
Supplemental Payments for Institutional/Non-Institutional Providers Fast-Track Stage complete. This regulation became effective on 02/13/2015.
2012 Reimbursement Methodology Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/14/2013.
Provider Preventable Conditions
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/25/2012.
Outpatient Rehabilitation Agency and Long Stay Hospital Reimbursement Final Stage complete. This regulation became effective on 08/16/2012.
2011 Budget Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2011.
2011 Technical Corrections for Reimbursment Regulations
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/27/2011.
2010 Reimbursement and Provider Termination Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2010.
2009 Hospital, Home Health, and Nursing Facility Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 03/17/2010.
2008 Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
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.
Clarification to Medicaid Utilization Calculation to Match Cost Report Practice Final Stage complete. This regulation became effective on 07/23/2008.
2007 Reimbursement Changes
Action is Exempt from Article 2 of the Administrative Process Act
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.
IME Payment Enhancement for High NICU Utilization Final Stage complete. This regulation became effective on 08/23/2006.
Modifications to Supplemental Payment Methods for Medicaid Public Providers. Final Stage complete. This regulation became effective on 08/23/2006.
Clarification to Medicaid Utilization Calculation to Match Cost Report Practice Emergency/NOIRA Stage withdrawn on 10/26/2005 before the Secretary's office completed its review.
Conform DSH Limit to Federal Legislation Fast-Track Stage complete. This regulation became effective on 11/06/2006.
Modification of Indirect Medical Education (IME) Payments Emergency/NOIRA Stage complete. Emergency regulation expired on 06/30/2006.
Modification of Indirect Medical Education Payments
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage withdrawn on 06/15/2005 before Attorney General's office completed its review.
Set Inpatient Hospital Adjustment Factor to 0.76
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2005.
Eliminate DSH for NICU Programs and Modify IME Final Stage complete. This regulation became effective on 09/01/2005.
Increase in DSH Limit for FY 2005 Fast-Track Stage complete. This regulation became effective on 06/06/2005.
Inpatient Hospital Adjustment Factor Increase Fast-Track Stage complete. This regulation became effective on 07/01/2005.
Reimbursement to Type One Hospitals for Operating Costs, DSH, and Indirect Medical Education Final Stage complete. This regulation became effective on 08/12/2004.
Exclude Freestanding Psychiatric Hospitals from Inpatient Hospital Rate Rebasing Emergency/NOIRA Stage complete. Emergency regulation expired on 08/31/2005.
Reduction of Hospital Capital Costs Final Stage complete. This regulation became effective on 07/01/2004.
Modify Lump Sum Adjustment
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/04/2004.
Inflation Factor for Inpatient Hospital Reibmursement 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.
Outpatient Hospital Reimbursement and Graduate Medical Education Final Stage complete. This regulation became effective on 07/01/2003.
Reduction of Inpatient Hospital Reimbursement Rates Final Stage complete. This regulation became effective on 08/01/2003.
Supplemental Payments for Inpatient/ Outpatient Hospitals NOIRA Stage withdrawn on 01/22/2003 prior to submission to DPB.
Limit Coverage of Out-of-State Inpatient Hospital Services Final Stage complete. This regulation became effective on 01/02/2002.
Provider Appeals Final Stage complete. This regulation became effective on 07/04/2001.
Diagnosis Related Groupings (DRG) Final Stage complete. This regulation became effective on 07/01/2000.

Withdrawn Actions
Action Title Latest Stage Status
Supplemental Payments for Freestanding Children's Hospitals Fast-Track Stage withdrawn on 09/29/2023 prior to submitting for AG review.
Graduate Medical Education Residency Slots Final Stage withdrawn on 07/16/2019 prior to submitting for AG review.
EVMS & VA Tech Carillion Supplemental Payments Fast-Track Stage withdrawn on 09/12/2018 during the public comment period.
Graduate Medical Education Residency Slots
Final Stage withdrawn on 06/18/2018 before Attorney General's office completed its review.
New Qualifying Hospitals Fast-Track Stage withdrawn on 08/09/2018 before the Governor's office completed its review.
CH 0080 Reimbursement - Hospitals Fast-Track Stage withdrawn on 03/10/2017 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.
Supplemental Payments for Private Hospital Partners Fast-Track Stage withdrawn on 12/18/2015 before Attorney General's office completed its review.
2010 Reimbursment Changes (Stimulus)
Final Stage withdrawn on 11/12/2013 before submission to the Registrar.
Outpatient Rehabilitation Agency and Long Stay Hospital Reimbursement Emergency/NOIRA Stage withdrawn on 05/15/2009 before Attorney General's office completed its review.
ljlj;lkljl; Emergency Stage withdrawn on 05/05/2003 prior to submitting for AG review.