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 26, 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 – Long-Term Care (12 VAC 30-90).  

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

In accordance with the 2026 Appropriation Act, DMAS will be making the following changes:

Methods & Standards for Establishing Payment Rates-Long-Term Care (12 VAC 30-90)

1. In accordance with Item 291.BBB, the state plan is being revised to provide direct and indirect operating rates equal to 25.4 percent above the calculated price-based rates for qualifying facilities where at least 80 percent of the resident population have one or more of the following diagnoses: quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy, with at least 90 percent Medicaid utilization and a case-mix index of 1.15 or higher in fiscal year 2014. This continues reimbursement authorized in Item 306, paragraph CCC 7 (Chapter 780, 2016 Acts of Assembly), and Item 313, paragraph KKKK of the 2020 Appropriation Act (Chapter 56, 2020 Special Session I Acts of Assembly).

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2027 or federal fiscal year 2028. 

2. In accordance with Item 291.LLL.1.b, the state plan is being revised to increase nursing home and specialized care per diem rates effective until June 30, 2027.  DMAS shall distribute the funding as an add-on payment to the per diem rates in effect as of June 30, 2026. This add-on payment shall be effective until June 30, 2027.

The expected increase in annual fee-for-service aggregate expenditures is $4,730,124 in state general funds and $5,069,876 in federal funds in federal fiscal year 2027, and there are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2028.