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).

DMAS is making these changes in its methods and standards for setting payment rates for services in order to comply with the legislative mandates set forth in the 2015 Acts of Assembly, Chapter 665, Item 301.

Reimbursement Changes Affecting Hospitals (12 VAC 30-70)

12VAC30-70-351 is being amended to:

1. Eliminate inflation for inpatient hospital operating, GME, DSH and IME payments, effective July 1, 2015.           

The expected decrease in annual aggregate expenditures is ($36,849,416).

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

12VAC30-80-30 is being amended to:

1. Eliminate the emergency room payment reduction for level III physician services for non-emergencies effective July 1, 2015.

The expected increase in annual aggregate expenditures is $4,460,000.

1. Increase supplemental payments for physicians affiliated with freestanding children’s hospitals with more than 50 percent Virginia Medicaid inpatient utilization effective July 1, 2015.

The expected increase in annual aggregate expenditures is $2,763,460.

1. Update the average commercial rate calculation of supplemental payments for physicians affiliated with a publicly funded medical school in Tidewater effective October 1, 2015.

The expected increase in annual aggregate expenditures is $100,000.

1. Establish supplemental payment for state clinics operated by the Virginia Department of Health (VDH) effective July 1, 2015.

The expected increase in annual aggregate expenditures is $300,000.

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

12VAC30-90 is being amended to:

1. Eliminate inflation for nursing facilities, effective July 1, 2015.

The expected decrease in annual aggregate expenditures is ($27,204,097).

1. Implement the "hold harmless provision" for nursing facilities that meet the bed capacity and occupancy requirements, reimbursing with the price-based operating rate rather than the transition operating rate for those facilities.  This change will be effective July 1, 2015.

The expected increase in annual aggregate expenditures is $320,122.

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.