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

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—Other Types of Care.  The Department intends to implement a site of service differential for RBRVS physician rates.  Payment for physician services in some cases will be recalibrated to implement different rates for services depending on the site of service, based on the relative value units (RVUs) for a procedure code published by the Centers for Medicare and Medicaid Services (CMS).  For procedure codes that can be performed in either a facility or non-facility, CMS has been publishing separate RVUs for several years and Medicare rates are based on site of service. 

Currently, DMAS uses only the non-facility RVU in calculating rates.  Different Medicaid rates by site of service will be phased-in over a four-year period.  After the phase-in, DMAS will use the Medicare facility RVU.  Different rates based on site of service will be implemented in a budget neutral manner.  Any savings in total reimbursement to physicians as a result of the implementation of site of service rates will be reallocated proportionately to all physician categories of service as a percentage increase. 

These changes are being made pursuant to the Department’s authority under Title XIX of the Social Security Act. 

 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 William Lessard, Director, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA  23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.com).  Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Mr. Lessard and such comments are available for review at the same address.