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 August 25, 2026

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 Meredith Lee, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, or via e-mail at: Meredith.Lee@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 Meredith Lee 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 (https://townhall.virginia.gov) on the General Notices page, found at:  https://townhall.virginia.gov/L/generalnotice.cfm

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).

In accordance with the 2026 Appropriation Act, Item 291.WWWWW.1 and 2, the state plan will be revised to allow DMAS to participate in the CMS Cell and Gene Therapy Access Model, which is a partnership between CMS and states to provide sickle cell treatments for Medicaid members. A previous SPA was filed with CMS to provide authority for value-based payment arrangements that are part of the Model.  This SPA reimburses hospitals for selected carved-out drugs separately from the inpatient All Patient Refined Diagnosis Related Group (APR-DRG) payment for drugs approved under the Model. A separate outpatient claim will be submitted by the hospital for the reimbursement of these drugs at the Acquisition Cost (AAC).

There are no expected increases or decreases in annual fee-for-service aggregate expenditures as a result of these changes.