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 create a new model for Medicaid coverage of case management services for children less than three years of age who receive services under Chapter 53 (§ 2.2-5300 et seq.) of Title 2.2 of the Code of Virginia in accordance with Part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1431 et seq.).  These children have (i) a 25% developmental delay in one or more areas of development, (ii) atypical development, or (iii) a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay.  This change is being made in response to a mandate from the 2011 Virginia General Assembly in Chapter 890, Item 297 UUUU of the 2011 Acts of Assembly.

DMAS intends to amend the Virginia State Plan for Medical Assistance to define a new approach to payment for case management services under Medicaid that supports the Part C early intervention model. The new Early Intervention Case Management service will meet federal Part C requirements for care coordination as well as federal Medicaid requirements for case management reimbursement.  In addition to coordinating specialized services needed to ameliorate the child’s developmental delay, the new case management model will facilitate coordination with the child’s primary care provider and support quality preventive services such as well child care, immunizations, and lead testing, covered under the Early and Periodic Screening, Diagnosis and Treatment provision for all children enrolled in Medicaid.

Some infants who receive services through the Part C early intervention program may also receive case management services for high risk pregnant women and children.  These services are designed to improve birth outcomes and reduce infant morality by increasing access to care and promoting continuity of care for women with a high risk pregnancy through the prenatal period and infancy.  Providers are limited to registered nurses and trained social workers with experience working with pregnant women.  Early Intervention Case Management providers will be required coordinate services with these case managers to avoid duplication of services.

The proposed Early Intervention Case Management service will reimburse for coordination services that are federally required by the Part C early intervention program to assist children and their families.  All local lead agencies under contract with DBHCS or their designees will be eligible to receive Medicaid reimbursement for case management services.  All private and governmental fee-for-service providers will be paid according to the same methodology.  These providers will be reimbursed pursuant to the agency’s fee, estimated at $120.00 per month, which is based on the actual requirements of the service.

DMAS anticipates implementing this amendment in a budget neutral manner. The projected savings associated with the elimination of payment for case management under the mental health and intellectual disabilities models for children served by the Part C early intervention program will offset the new costs incurred under the new model for the entire Part C population covered by Medicaid.   

The Department is submitting emergency regulations, pursuant to the Code of Virginia §2.2-4011, to the Governor for approval.  Pending the Governor’s approval of the emergency regulations, DMAS will provide copies of said emergency regulations to all requesters, along with proposed provider-specific reimbursement rates.  Please forward your written request to the Regulatory Coordinator, DMAS, 600 East Broad Street, Richmond, VA, 23219.  Written comments about this reimbursement methodology change may also be directed to the DMAS Regulatory Coordinator. DMAS does not anticipate holding a public hearing on this regulatory action. Further information is also available at http://townhall.virginia.gov/L/viewaction.cfm?actionid=3535&display=stages.