Department of Medical Assistance Services [602]
Secretarial Area: Health and Human Resources
Operating Budget Summary
This table shows the Governor's proposed budget for the next two years and the agency's official budget for the previous six years.
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Biennium Fiscal Year Source GF NGF Total
2010-2012 2011 Chapter 2, 2012 Acts of Assembly $2,822,298,324 $4,710,248,288 $7,532,546,612
2010-2012 2012 Chapter 2, 2012 Acts of Assembly $3,367,186,774 $4,045,504,873 $7,412,691,647
2012-2014 2013 Chapter 1, 2014 Acts of Assembly $3,547,761,312 $4,525,123,550 $8,072,884,862
2012-2014 2014 Chapter 1, 2014 Acts of Assembly $3,669,406,166 $4,829,310,906 $8,498,717,072
2014-2016 2015 Chapter 732, 2016 Acts of Assembly $3,846,847,641 $4,786,951,421 $8,633,799,062
2014-2016 2016 Chapter 732, 2016 Acts of Assembly $4,266,731,052 $5,073,691,875 $9,340,422,927
2016-2018 2017 Chapter 836, 2017 Acts of Assembly $4,450,859,097 $5,472,509,199 $9,923,368,296
2016-2018 2017 Previous Legislative Appropriation $4,411,533,662 $5,329,249,375 $9,740,783,037
2016-2018 2017 Governor's Amendments $43,290,346 $147,224,735 $190,515,081
2016-2018 2017 General Assembly Adjustments ($3,964,911) ($3,964,911) ($7,929,822)
2016-2018 2018 Chapter 836, 2017 Acts of Assembly $4,729,698,510 $5,623,286,311 $10,352,984,821
2016-2018 2018 Previous Legislative Appropriation $4,547,698,514 $5,436,918,443 $9,984,616,957
2016-2018 2018 Governor's Amendments $185,827,363 $184,433,704 $370,261,067
2016-2018 2018 General Assembly Adjustments ($3,827,367) $1,934,164 ($1,893,203)
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
2010-2012 2011 Chapter 2, 2012 Acts of Assembly 169.82 194.18 364.00
2010-2012 2012 Chapter 2, 2012 Acts of Assembly 176.32 204.68 381.00
2012-2014 2013 Chapter 1, 2014 Acts of Assembly 183.82 212.18 396.00
2012-2014 2014 Chapter 1, 2014 Acts of Assembly 198.32 226.68 425.00
2014-2016 2015 Chapter 732, 2016 Acts of Assembly 210.37 216.63 427.00
2014-2016 2016 Chapter 732, 2016 Acts of Assembly 225.02 234.98 460.00
2016-2018 2017 Chapter 836, 2017 Acts of Assembly 232.02 241.98 474.00
2016-2018 2017 Previous Legislative Appropriation 232.02 241.98 474.00
2016-2018 2017 Governor's Amendments 0.00 0.00 0.00
2016-2018 2017 General Assembly Adjustments 0.00 0.00 0.00
2016-2018 2018 Chapter 836, 2017 Acts of Assembly 240.02 249.98 490.00
2016-2018 2018 Previous Legislative Appropriation 232.02 241.98 474.00
2016-2018 2018 Governor's Amendments 1.50 1.50 3.00
2016-2018 2018 General Assembly Adjustments 6.50 6.50 13.00
Operating Budget Addenda (in order of greatest impact)
•
Fund Medicaid utilization and inflation Decision Package
  Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent forecast expenditures.
 
  FY FY
General Fund $84,322,141 $196,343,872
Nongeneral Fund $109,934,259 $162,757,446
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Tobacco taxes are projected to decrease by $2.8 million in FY 2017 and $4.4 million in FY 2018 based on the Department of Taxation's revised forecast. Conversely, Medicaid recoveries are expected to increase by $10.6 million in FY 2017 and $13.6 million in FY 2018. The estimates also account for a $44.3 million prior year cash balance carried over from FY 2016. Since the fund is used as state match for Medicaid, any change in revenue to the fund impacts general fund support for Medicaid.
 
  FY FY
General Fund ($34,705,234) ($9,231,567)
Nongeneral Fund $34,705,234 $9,231,567
•
Adjust Medicaid forecast to account for revised Medicare premiums Decision Package
  Accounts for Medicare premium rates that were finalized after the consensus Medicaid forecast was completed. During the development of the Medicaid forecast, due November 1, the Departments of Planning and Budget and Medical Assistance Services had to use preliminary assumptions on Medicare premium rates. Since the forecast was finalized, the federal government has released actual Medicare Part A, B, and D rates for FY 2017. The changes will allow the forecast to be lowered by $47.2 million total funds (over the biennium); thereby reducing the general fund need by $25.5 million.
 
  FY FY
General Fund ($7,293,635) ($18,238,863)
Nongeneral Fund ($6,165,602) ($15,460,168)
•
Fund Family Access to Medical Insurance Security utilization and inflation Decision Package
  Adjusts funding for the FAMIS program to reflect the latest forecast of expenditures. The costs are primarily a result of higher than expected managed care rates and an increase in service utilization.
 
  FY FY
General Fund $2,262,730 $2,789,519
Nongeneral Fund $16,374,286 $19,890,297
•
Adjust appropriation to reflect current services Decision Package
  Adjusts the agency's base budget to reflect current operations. The amendment adds $8.0 million of federal appropriation in each year that was omitted in last year's budget. In addition, $20.0 million is reduced annually to reflect expected expenditures in the federal provider incentive payment program as more providers complete their payment cycles. This technical action makes the Appropriation Act more transparent and limits the need for administrative transactions.
 
  FY FY
Nongeneral Fund ($12,000,000) ($12,000,000)
•
Allow consumer-directed attendants to receive overtime pay for up to 56 hours Decision Package
  Authorizes the Department of Medical Assistance Services (DMAS) to pay overtime compensation to attendants who are providing care under the consumer-directed service option in the Medicaid waivers. This amendment replaces current language prohibiting overtime hours being worked by consumer-directed attendants with language that allows DMAS to pay time and a half for up to 56 hours for a single attendant who works more than 40 hours per week.
 
  FY FY
General Fund $0 $8,535,844
Nongeneral Fund $0 $8,535,844
•
Fund medical assistance services for low-income children utilization and inflation Decision Package
  Adjusts funding for the Commonwealth's Medicaid Children's Health Insurance Program to reflect the latest expenditure forecast. Children between the ages of 6 and 19, with family income from 100 to 133 percent of the federal poverty level, are eligible for this program. The costs are largely attributable to increased managed care rates and higher utilization of services.
 
  FY FY
General Fund $657,633 $927,937
Nongeneral Fund $4,426,558 $5,967,768
•
Restore inflation for nursing facilities Decision Package
  Funds the full value of inflation, an adjustment of 2.5 percent, for nursing facilities in fiscal year 2018. Chapter 780 assumes an inflation adjustment of 1.25 percent in fiscal year 2018.
 
  FY FY
General Fund $0 $5,454,111
Nongeneral Fund $0 $5,454,111
•
Provide same-day access to evaluation services at community services boards Decision Package
  Funds the Medicaid costs associated with providing assessment and evaluation services to individuals through local community services boards and behavioral health authorities as a result of the implementation of the same-day access initiative. An accompanying amendment in the Department of Behavioral Health and Developmental Services accounts for the non-Medicaid population served as a result of this initiative.
 
  FY FY
General Fund $0 $1,332,750
Nongeneral Fund $0 $1,332,750
•
Reflect October 2016 Savings in agency budgets Decision Package
  Reflects the savings included in the Governor's October 2016 Savings Plan.
 
  FY FY
General Fund ($2,003,289) $0
•
Conduct audits of "DRG" payments using agency staff Decision Package
  Captures savings associated with performing audits with agency staff. The shift to managed care reduces fee-for-service business, lowers the volume of services DMAS needs to audit, and makes it possible for the agency to complete hospital diagnosis related group (DRG) payment audits without an outside contractor.
 
  FY FY
General Fund $0 ($688,013)
Nongeneral Fund $0 ($688,013)
•
Enhance estate recovery efforts Decision Package
  Increases the size of the estate recovery program from two positions to five. The department maintains that the additional positions will enhance the efforts of the Medicaid recovery unit to improve collections by an estimated $1.0 million total funds.
 
  FY FY
General Fund $0 ($372,318)
Nongeneral Fund $0 $620,530
Positions 0.00 3.00
•
Reduce funding for contract reprocurements for fiscal year 2018 Decision Package
  Captures funding associated with delayed reprocurements. Chapter 780 provided $800,000 general fund in FY 2018 for the agency to cover contract reprocurement costs. The anticipated procurements will now occur one year later than previously assumed; therefore only half of the funding for FY 2018 is necessary. All FY 2017 funding was captured as part of the 2017 savings plan.
 
  FY FY
General Fund $0 ($400,000)
Nongeneral Fund $0 ($400,000)
•
Conduct audits of "DME" and pharmacy services with agency staff Decision Package
  Assumes that more durable medical equipment (DME) and pharmacy audits will be performed using agency staff. The shift to managed care reduces fee-for-service business, lowers the volume of services DMAS needs to audit, and makes it possible for the agency to complete more audits using agency staff and a reduced number of contracts with vendors.
 
  FY FY
General Fund $0 ($373,433)
Nongeneral Fund $0 ($373,433)
•
Fund medical services for involuntary mental commitments Decision Package
  Increases funding for the cost of hospital and physician services for persons subject to an involuntary mental commitment. The most recent forecast of expenditures projects higher FY 2018 costs than previously estimated.
 
  FY FY
General Fund $0 $605,189
•
Capture administrative savings Decision Package
  Accounts for savings associated with improved agency operations and efficiencies initiated by the Office of Medical Director.
 
  FY FY
General Fund $0 ($279,887)
Nongeneral Fund $0 ($279,887)
•
Capture turnover and vacancy savings Decision Package
  Accounts for savings associated with agency positions being vacant for longer periods of time.
 
  FY FY
General Fund $0 ($264,113)
Nongeneral Fund $0 ($264,113)
•
Adjust institutional rate setting/auditing scope of work consistent with payment methodology changes Decision Package
  Transitions to more price-based (less cost-based) payment systems has reduced the need to audit costs, so the agency can revise the scope of institutional provider rate setting and auditing.
 
  FY FY
General Fund $0 ($250,000)
Nongeneral Fund $0 ($250,000)
•
Assume higher nongeneral fund share of information technology staff costs Decision Package
  Captures general fund dollars associated with certain DMAS staff who now qualify for a higher federal match rate (75 percent or 90 percent) than currently assumed (50 percent).
 
  FY FY
General Fund $0 ($250,000)
Nongeneral Fund $0 $250,000
•
Reduce contract costs for the Cover Virginia Call Center and Central Processing Unit Decision Package
  Generates savings by reducing the cost of the contracts associated with the Cover Virginia Call Center and Central Processing Unit.
 
  FY FY
General Fund $0 ($106,237)
Nongeneral Fund $0 ($318,711)
•
Correct fund split for prior action related to the MLTSS initiative Decision Package
  Adds general fund dollars to fully fund the oversight costs of implementing the Managed Long-Term Services and Supports (MLTSS) initiative. The funding provided in Chapter 780 over-appropriates the federal share while shorting the general fund need. This technical amendment corrects the fund split used in last year's MLTSS budget amendment.
 
  FY FY
General Fund $50,000 $125,000
Nongeneral Fund ($50,000) ($125,000)
•
Perform federally required substance abuse (ARTS) waiver evaluation Decision Package
  Provides funding to conduct an independent evaluation of the new Addiction and Recovery Treatment (ARTS) benefit, as required by the federal government. During waiver negotiations in summer 2016, the Centers for Medicare and Medicaid Services (CMS) informed the department that the Commonwealth must contract with external academic researchers to conduct an independent evaluation to determine the effectiveness of the state’s ARTS training and the impact of the ARTS benefit and waiver on members’ health outcomes, service utilization and health care costs.
 
  FY FY
General Fund $0 $150,000
Nongeneral Fund $0 $150,000
•
Conduct readiness reviews for new managed care organizations Decision Package
  Provides funding to conduct readiness reviews for new managed care organizations (MCO). The new organizations would operate as part of the re-procured Medallion (4.0) program, which currently serves more than 700,000 individuals. A readiness review is an impartial assessment to assess a health plan’s preparedness to operate as a Medicaid MCO.
 
  FY FY
General Fund $0 $67,572
Nongeneral Fund $0 $202,716
•
Assume a higher federal match rate for software licenses Decision Package
  Captures general fund savings associated with a higher federal match rate. Change in federal policy with respect to match rates for certain information technology expenses will allow the agency to reduce the state share of a large license cost from 50 percent to 25 percent.
 
  FY FY
General Fund $0 ($125,000)
Nongeneral Fund $0 $125,000
•
Comply with federal access requirements Decision Package
  Provides funding to comply with new federal requirements to conduct service access analysis. The Centers for Medicare and Medicaid Services (CMS) promulgated a new rule in November 2015 for the purpose of ensuring that states comply with access standards in the Social Security Act and regulations.
 
  FY FY
General Fund $0 $75,000
Nongeneral Fund $0 $75,000
•
Clarify Commonwealth Coordinated Care (CCC) reporting requirements Decision Package
  Modifies the reporting requirement for the Commonwealth Coordinated Care (CCC) program to clarify that the report is due 30 days after the end of each quarter. Current language makes this report due at the end of the quarter, which is technically the day after the quarter ends. However, the data required to complete the report is not available until after the quarter ends. This language amendment allows the agency to be in compliance with Act requirements.
•
Ensure all appropriated Virginia Health Care Fund cash is available for expenditure Decision Package
  Provides the agency with a $15.0 million line of credit to ensure that all cash deposited into the Virginia Health Care Fund is available to expend in the fiscal year in which it was appropriated.
•
Restore Prohibition on Personal Attendant Overtime General Assembly Adjustment
  This amendment restores language contained in Chapter 780, 2016 Acts of Assembly which prohibits Medicaid payment of overtime for consumer-directed personal assistance, respite and companion services. In addition, language authorizing overtime beginning July 1, 2017 is eliminated along with funding of $8.5 million from the general fund and $8.5 million from nongeneral funds.
 
  FY FY
General Fund $0 ($8,535,844)
Nongeneral Fund $0 ($8,535,844)
•
Medicaid Forecast Adjustment General Assembly Adjustment
  This amendment reduces funding by $3.7 million from the general fund and $3.7 million in nongeneral funds the first year and $3.6 million from the general fund and $3.6 million in nongeneral funds the second year based on an analysis of expenditures year-to-date in fiscal year 2017. The most recent Medicaid forecast of expenditures was completed in November 2016 and the additional months of data since then indicate that expenditures are tracking slightly behind the forecast.
 
  FY FY
General Fund ($3,714,911) ($3,630,270)
Nongeneral Fund ($3,714,911) ($3,630,270)
•
Increase Nursing Facility Payments General Assembly Adjustment
  This amendment adds $3.3 million from the general fund and $3.3 million from matching federal Medicaid funds to increase payments for nursing homes effective July 1, 2017. Language changes the price percentages for direct and indirect care. The change will help mitigate the effect of rebasing nursing facility rates utilizing base year costs that reflect multiple years of artificially constrained payments due to budgetary constraints. By increasing the price percentages as designated, the Commonwealth will promote a more equitable reimbursement policy to ensure long-term availability of nursing facility services for Medicaid recipients for whom such care is appropriate.
 
  FY FY
General Fund $0 $3,260,683
Nongeneral Fund $0 $3,260,683
•
Expand GAP Eligibility to 100% of the Federal Poverty Level & Increase Services General Assembly Adjustment
  This amendment adds $2.0 million from the general fund and $2.0 million in federal matching Medicaid funds the second year to modify the income eligibility criteria for the Medicaid demonstration waiver program for adults with serious mental illness in Medicaid from 80 to 100 percent of the federal poverty level effective October 1, 2017. The waiver provides primary care, outpatient medical services, and prescription drugs, along with a robust set of behavioral health services to adults with serious mental illness. In addition, language adds addiction recovery and treatment services, including partial day hospitalization and residential treatment to those services already provided through the waiver. A companion amendment in Item 310 provides additional funding for the GAP expansion for mental health screenings and attendant administrative costs.
 
  FY FY
General Fund $0 $2,017,088
Nongeneral Fund $0 $2,017,088
•
HB 2417 Medicaid Fraud Prevention & Prepayment Analytics General Assembly Adjustment
  This amendment adds $371,000 from the general fund and $3.0 million from matching federal Medicaid funds for the fiscal impact of House Bill 2417 which directs the Department of Medical Assistance Services to establish a program using prepayment analytics to mitigate the risk of improper payments to providers of services furnished under the state plan for medical assistance who commit fraud, abuse, or errors.
 
  FY FY
General Fund $0 $371,000
Nongeneral Fund $0 $2,964,000
•
Modify Peer Group Assignment for Danville, Pittsylvania Nursing Facilities General Assembly Adjustment
  This amendment adds funding and language to correct the unintended consequence of changing the designation of the Danville and Pittsylvania County peer group for purposes of calculating Medicaid nursing home reimbursement for nursing facilities located in these localities from a Metropolitan Statistical Area to a Micropolitan Statistical Area. The Department of Medical Assistance Services made this change in 2013 when it implemented the Medicaid Price-Based Payment System for nursing facilities. However, the consequences of this change was not fully understood until the agency began analyzing nursing facility data in preparation of nursing facility rebasing.
 
  FY FY
General Fund $0 $1,603,910
Nongeneral Fund $0 $1,603,910
•
Restore FY 18 Inflation for CHKD Medicaid Payments General Assembly Adjustment
  This amendment adds $1.4 million from the general fund and $1.4 million from matching federal Medicaid funds the second year and strikes language which would have prohibited the payment of an inflation adjustment in inpatient hospital payments to Children's Hospital of the King's Daughters (CHKD) in fiscal year 2018. Language contained in the budget would have effectively reduced CHKD's inpatient hospital payments as well as Disproportionate Share Hospital, graduate medical education and indirect medical education payments.
 
  FY FY
General Fund $0 $1,374,722
Nongeneral Fund $0 $1,374,722
•
Medicaid Recoveries General Assembly Adjustment
  This amendment reduces Medicaid expenditures in the second year by $1.0 million from the general fund and increases nongeneral funds in the Virginia Health Care Fund (VHCF) by $1.0 million from expanded estate recovery efforts. The introduced budget provides funding for three additional positions for the estate recovery program. Under Medicaid law, following the death of the Medicaid recipient a state must attempt to recover from his or her estate whatever long-term care benefits it paid for the recipient's care. Recoveries are deposited into the VHCF and used to offset the general fund spending for the Medicaid Program.
 
  FY FY
General Fund $0 ($1,000,000)
Nongeneral Fund $0 $1,000,000
•
Medicaid Improvements in Long-Term Services and Supports Screening General Assembly Adjustment
  This amendment adds $687,500 from the general fund and a like amount of matching federal Medicaid funds the second year, four positions and language to implement recommendations from a recent review of the Virginia Medicaid Program by the Joint Legislative Audit and Review Commission to improve the reliability of Medicaid screening for long-term services and supports.
 
  FY FY
General Fund $0 $687,500
Nongeneral Fund $0 $687,500
Positions 0.00 4.00
•
Capture Unsubscribed Funds for New Medicaid Medical Residencies General Assembly Adjustment
  This amendment captures $500,000 from the general fund in savings from unsubscribed funds for the Medicaid medical residency program for fiscal year 2018. The 2016 General Assembly provided funding for a new program to fund 25 medical residency slots effective July 1, 2017, of which 13 were for primary care residencies and 12 for high-need specialty residencies. Currently, 15 residency slots have been awarded to hospitals for fiscal year 2018. Typically institutional decisions about medical residencies are made in early fall and awarded to students the following spring, consequently, funding for the unsubscribed slots will not be used in fiscal year 2018. In addition, language specifies the hospitals for which supplemental payments will be made to fund residencies, based on the decisions made in the fall of 2016. Language reserves any unused funding for Medicaid residency slots to be used for future costs of the residency program and requires the Department of Medical Assistance Services to adjust the 2018-20 Medicaid forecast to include funding for the 25 residency slots approved by the 2016 General Assembly.
 
  FY FY
General Fund $0 ($500,000)
Nongeneral Fund $0 ($500,000)
•
Maximize Intermediate Care Provider Assessment General Assembly Adjustment
  This amendment captures $500,000 in general fund savings by increasing the provider assessment on Intermediate Care Facilities for the Intellectually Disabled (ICF-ID). The current assessment is set at 5.5 percent but federal law allows a maximum of 6.0 percent. This amendment increases the assessment to 6.0 percent. The assessment on ICF-IDs generates additional state dollars used as matching funds to draw down federal Medicaid funds and applies to both private and state providers. The assessment increases the costs of ICF-IDs which can then be reimbursed by Medicaid keeping revenues for the facility whole.
 
  FY FY
General Fund $0 ($500,000)
Nongeneral Fund $0 $500,000
•
HB 2304 Long-Term Care Requirements of DMAS General Assembly Adjustment
  This amendment adds $478,394 from the general fund and $478,394 from matching federal Medicaid funds and seven positions in the Department of Medical Assistance Services to implement the provisions of House Bill 2304 which reflects the JLARC recommendations related to improving spending in the Medicaid program.
 
  FY FY
General Fund $0 $478,394
Nongeneral Fund $0 $478,394
Positions 0.00 7.00
•
Managed Care Requirements and Oversight General Assembly Adjustment
  This amendment includes budget language directing the Department of Medical Assistance Services to implement various Joint Legislative Audit and Review Committee recommendations related to oversight of the Medicaid managed care programs. In addition, $357,502 from the general fund and a like amount of federal matching funds is provided for the costs associated (i.e. actuarial costs) with implementing the provisions.
 
  FY FY
General Fund $0 $357,502
Nongeneral Fund $0 $357,502
Positions 0.00 1.00
•
Administrative Savings General Assembly Adjustment
  This amendment captures $250,000 from the general fund and $250,000 in federal funds the first year in administrative savings.)
 
  FY FY
General Fund ($250,000) $0
Nongeneral Fund ($250,000) $0
•
Administrative Costs Related to GAP Expansion General Assembly Adjustment
  This amendment adds $111,521 from the general fund and $280,052 in enhanced federal Medicaid matching funds for the administrative costs associated with expanding the Medicaid demonstration waiver program for adults with serious mental illness (GAP) from 80 percent to 100 percent of the federal poverty level effective October 1, 2017. Funding will be used for additional mental health screenings, eligibility processing and other related administrative costs. A companion amendment in Item 306 provides funding for the GAP expansion.
 
  FY FY
General Fund $0 $111,521
Nongeneral Fund $0 $280,052
•
Medicaid MCO Reports on Pharmacy Claims General Assembly Adjustment
  This amendment adds $76,427 from the general fund and $76,427 from matching federal Medicaid funds, one position and language directing the Department of Medical Assistance Services (DMAS) to include language in all its managed care contracts requiring quarterly reports on details related to pharmacy claims. Language requires DMAS to provide a report using aggregate data to the Chairmen of the House Appropriations and Senate Finance Committee on the implementation of this initiative and impact on program expenditures by December 1, 2017. Language is added to ensure the confidentiality and prohibit disclosure of proprietary information related to the report.
 
  FY FY
General Fund $0 $76,427
Nongeneral Fund $0 $76,427
Positions 0.00 1.00
•
Add 144 Family & Individual Support Waiver Slots General Assembly Adjustment
  This amendment adds 144 Medicaid Family and Individual Support Waiver slots in the second year. Funding is contained in the introduced budget to provide funding for these slots. Projections of utilization of the newly designed Building Independence, Family and Individual Supports and Community Living Waivers programs have resulted in the ability to serve more individuals than originally anticipated. Language in the introduced budget is eliminated which would have delayed access to additional waiver slots in fiscal year 2018.
•
Allow Customized Rates for Sponsored Residential Services General Assembly Adjustment
  This amendment adds sponsored residential services to the list of services that are eligible to receive customized rates in Medicaid for providing services to individuals with high needs. While the rate structure is designed to provide higher reimbursement for high-need individuals there are exceptions in which a special rate is needed to help care for individuals with extremely high levels of need.
•
Developmental Disability Waivers Workgroup General Assembly Adjustment
  This amendment adds language directing the Department of Behavioral Health Developmental Services, in cooperation with the Department of Medical Assistance Services, to convene an annual stakeholders workgroup on issues related to the developmental disability waiver programs. Specifically, the workgroup will examine issues related to the tools to assess individual support needs, the assigned payment levels for providers, and the communication of these matters to individuals, families, case managers, providers and others.
•
Impact of Waiver Changes on Sponsored Residential Services General Assembly Adjustment
  This amendment modifies language in the introduced budget approved by the 2016 General Assembly to have the Department of Medical Assistance Services, in cooperation with the Department of Behavioral Health and Developmental Services, collect information and feedback related to payments to family homes and the impact of changes to the rates on family homes statewide from sponsored residential providers and family home providers. Language extends collaborative efforts to collect information and feedback to other provider groups and specifies additional data elements to review. Language also requires a report on the findings of this analysis to the Governor and the Chairmen of the money committees.
•
Implement Electronic Visit Verification General Assembly Adjustment
  This amendment adds language directing the agency to implement an Electronic Visit Verification (EVV) system for use by aides providing Medicaid consumer-directed personal care, respite care and companion services. In addition, it provides that for agency care the agency should work with stakeholders to develop standards for EVV systems that meet federal requirements. The federal 21st Century Cures Act requires states to use EVV for these services by January 1, 2019.
•
Increase Availability of Agency Data to the Public General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to create a web-based interface for the public to easily access agency data.
•
Medicaid Appeals General Assembly Adjustment
  This amendment adds language regarding the Medicaid appeals process to: (i) amend regulations to clarify that the informal appeals agent shall have the ability to close an informal appeal based on settlement between the parties up to $250,000; (ii) direct the agency to convene a workgroup to develop a plan to avoid or adjust retractions of Medicaid payments for non-material breaches of the Provider Participation Agreement when the provider has substantially complied with it; and (iii) require the agency to report on the status of the plan to avoid retractions to the Chairmen of House Appropriations and Senate Finance Committees.
•
Medicaid Pharmacy Liaison Committee Meetings and Input General Assembly Adjustment
  This amendment adds language directing the agency to meet with the Pharmacy Liaison Committee at least semi-annually and solicit input regarding pharmacy provisions in the development and enforcement of all managed care contracts.
•
Modify Supplemental Payment Methodology for Public Nursing Homes General Assembly Adjustment
  This amendment adds language related to supplemental Medicaid payments for local government-owned nursing homes. Currently five local-government owned nursing homes provide the Department of Medical Assistance Services (DMAS) with funding to draw down matching federal funds for reimbursement for services provided to Medicaid recipients. A portion of the matching federal funds are retained by DMAS as Certified Public Expenditure Revenues. New federal regulations prevent Medicaid from making supplemental payments to these facilities when DMAS implements its managed long-term care services and supports program (CCC Plus) on August 1, 2017. This language would exempt residents admitted to these facilities from the CCC Plus program, similar to how DMAS treats Virginia's veteran nursing facilities, unless the department has secured federal approval to use a minimum fee schedule for these facilities. Language would prohibit CCC Plus contracted health plans from limiting Medicaid recipients from choosing to receive nursing home services from these facilities.
•
Notice of MCO Rate Setting and Impact General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to notify the Director, Department of Planning and Budget, and the Chairmen of the House Appropriations and Senate Finance Committees prior to any change in the rates for Medicaid managed care companies, and to provide an estimate of the impact any such change would have on the state budget.
•
Nursing Facility Payments in Managed Care General Assembly Adjustment
  This amendment adds language directing the Department of Medical Assistance Services to amend the managed care regulations to reflect that payments for nursing facilities and specialized care services are no less than the established per diem amounts set by the department's reimbursement methodologies. The language does not change the current contracts for long term care supports and services, but requires the managed care regulations to reflect current practice.
•
Restore Language Prohibiting Medicaid Expansion General Assembly Adjustment
  This amendment restores language contained in Chapter 780, 2016 Acts of Assembly which conditions the expansion of Medicaid, pursuant to the federal Patient Protection and Affordable Care Act (PPACA), upon an appropriation by the General Assembly. Language is eliminated which provides authority to expand Medicaid pursuant to the PPACA on or after October 1, 2017. A companion amendment in Part 4 eliminates any language changes which would allow for such an expansion without an appropriation by the General Assembly.
•
Revise IME Payments for CHKD General Assembly Adjustment
  This amendment adds language related to indirect medical education (IME) payments to Children's Hospital of the King's Daughters (CHKD) to ensure that CHKD continues to receive Medicaid payments up to the uncompensated care cost limit as authorized by the General Assembly. The 2013 General Assembly authorized the use of indirect medical education payments to CHKD in view of expected declines in the state's allocation of disproportionate share hospital (DSH) payments by the federal government. This amendment ensures that in light of recent federal action by the Centers for Medicare and Medicaid related to the calculation of DSH, CHKD will continue to receive total payments consistent with the intent of the General Assembly. Language is added to ensure that the formula used for indirect medical education for inpatient hospital services reimbursed by Medicaid managed care providers is identical to that used for the state's two teaching hospitals.
•
Strike supplemental payment language General Assembly Adjustment
  This amendment removes language requiring the Department of Medical Assistance Services (DMAS) to make supplemental payments to certain private hospitals. In order to offset some portion of the added cost of these payments, state agencies not associated with the Medicaid program would be required to transfer funds currently budgeted for safety net and other human services into the Medicaid program. While it may be speculated that private hospitals may voluntarily work with the impacted programs to preserve these services, there is not and cannot be any assurance that this will occur without violating federal rules. Should the federal government determine any arrangements exists between enhanced payments and services being provided by the hospitals on behalf of the state, the associated Medicaid payments would be deemed improper, leading to disallowances and thereby creating a financial liability for the Commonwealth. Further, it is not appropriate to create the expectation among these private hospitals that the Commonwealth will be able to provide these supplemental payments. The budget as enrolled does not provide any funding specifically for these; instead, it relies on the transfer of funds currently appropriated for ongoing services.
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Supplemental Hospital Payments Program General Assembly Adjustment
  This amendment authorizes agencies within the Secretariat of Health and Human Resources to transfer funds to the Department of Medical Assistance Services (DMAS) to be used to pay the state share of Medicaid supplemental payments to qualifying hospitals. These Medicaid supplemental payments reimburse qualifying hospitals for their uncompensated costs for Medicaid services they have already provided. Language requires that 10 percent of the funding transferred shall be unalloted and revert to the general fund at the end of the year. Language directs the participating hospitals to report to DMAS on the services and programs provided and directs the department to report on the program by December 1 annually. It also clarifies that if federal laws, regulations or polices no longer allow such supplemental payments, that the Commonwealth is not obligated to continue such payments. Finally, language requires DMAS to monitor the capacity under the federal Upper Payment Limit for all hospital supplemental payment programs and adjust payments when the cap is reached by reducing or eliminating payments as necessary to stay within the cap with the newest payments impacted first.
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Supplemental Medicaid Payments to Certain Teaching Hospitals General Assembly Adjustment
  This amendment adds language providing the Department of Medical Assistance Services (DMAS) with the authority to implement supplemental Medicaid payments to teaching hospitals affiliated with an accredited medical school in Planning District 23 and Planning District 5 based on the department's reimbursement methodology established for such payments and/or its contracts with managed care organizations. The state's share of funding for the supplemental payments shall be provided by the accredited medical schools, Eastern Virginia Medical School and the Virginia Tech Carilion School of Medicine. Companion amendments in Item 247 and 4-5.03 b.3. authorize the transfer of funds from these schools to DMAS for this purpose.


p3_bullets - Official Enacted Budget - 06-08-2025 00:20:09