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 Amount, Duration, and Scope of Medical and Remedial Care Services (12 VAC 30-50); Methods and Standards for Establishing Payment Rates—Inpatient Hospital Services (12 VAC 30-70); Methods and Standards for Establishing Payment Rates—Other Types of Care (12 VAC 30-80); and Methods and Standards for Establishing Payment Rates—Long Term Care (12 VAC 30-90).  The Department is implementing a number of changes in reimbursement methodology effective July 1, 2014, pursuant to Item 301 of the 2014 Appropriation Act.  If the final Appropriation Act modifies these anticipated changes, the Department will subsequently publish an amended notice.  Citations are to state regulations that correspond to the Medicaid State Plan.  Estimated impact on providers in FY15 is included.

 Reimbursement Changes Affecting Hospitals (12 VAC 30-70)

12 VAC 30-70-221 is being amended to:

Implement All Patient Refined-Diagnosis-Related Group reimbursement methodology for inpatient hospitals.

Anticipated Provider Fiscal Impact = $0

12 VAC 30-70-301 is being amended to:

Establish a new methodology for DSH reimbursement. 

Anticipated Provider Fiscal Impact = $0

12 VAC 30-70-351 is being amended to:

Eliminate inflation for inpatient hospital operating, GME, DSH and IME payments in FY15.

Anticipated Provider Fiscal Impact = ($32,694,706)

12 VAC 30-70 and 12VAC30-80 are being amended to:

Establish supplemental inpatient and outpatient hospital payments for partners of Type One hospitals. 

Anticipated Provider Fiscal Impact = $3,422,675

Reimbursement Changes Affecting Other Providers (12 VAC 30-80)

An effective date change will be made in the fee schedule corresponding to a change in the billing unit for mental health support services from a block of time to 15-minute increments (12 VAC 30-50-226.

Anticipated Provider Fiscal Impact = $0

12 VAC 30-80-30 is being amended to:

Reduce clinical lab fees by 12 percent to match the laboratory rates paid by Medicaid managed care organizations.

Anticipated Provider Fiscal Impact = ($2,127,356)

Reduce DME rates to Medicare competitive bid rates if they are lower than DMERC minus 10 percent.

 Anticipated Provider Fiscal Impact = ($4,866,000)

Increase supplemental payments for freestanding children’s hospitals with more than 50 percent Medicaid inpatient utilization.

Anticipated Provider Fiscal Impact = $2,763,460

Establish supplemental payments for physicians affiliated with publicly funded medical school.

Anticipated Provider Fiscal Impact = $2,149,138

12 VAC 30-80-200 is being amended to:

Eliminate inflation adjustments in FY 2015 and FY 2016 for outpatient rehabilitation agency rates.

 Anticipated Provider Fiscal Impact = ($413,744)

12 VAC 30-80-180 is being amended to:

Eliminate inflation adjustments in FY 2015 and FY 2016 for home health agency rates.

Anticipated Provider Fiscal Impact = ($154,126)

Reimbursement Changes Affecting Nursing Facilities (12 VAC 30-90)

12 VAC 30-90 is being amended to:

Replace cost-based reimbursement methodology for nursing facilities with a price-based reimbursement methodology including reductions in the rental rate floor for capital reimbursement.  

Anticipated Provider Fiscal Impact = $0

Make additional reductions to the rental rate floor for nursing facility capital reimbursement.

Anticipated Provider Fiscal Impact = ($8,123,510)

Establish supplemental nursing facility payments for government-owned facilities.

 Anticipated Provider Fiscal Impact = $13,600,000

 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, 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.