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.
more...
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 780, 2016 Appropriation Act $4,411,533,662 $5,329,249,375 $9,740,783,037
2016-2018 2017 Base Budget $4,099,194,548 $4,937,490,107 $9,036,684,655
2016-2018 2017 Governor's Amendments $270,822,905 $1,096,840,833 $1,367,663,738
2016-2018 2017 General Assembly Adjustments $41,516,209 ($705,081,565) ($663,565,356)
2016-2018 2018 Chapter 780, 2016 Appropriation Act $4,547,698,514 $5,436,918,443 $9,984,616,957
2016-2018 2018 Base Budget $4,099,194,548 $4,937,490,107 $9,036,684,655
2016-2018 2018 Governor's Amendments $409,880,995 $2,805,577,769 $3,215,458,764
2016-2018 2018 General Assembly Adjustments $38,622,971 ($2,306,149,433) ($2,267,526,462)
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 780, 2016 Appropriation Act 232.02 241.98 474.00
2016-2018 2017 Base Budget 225.02 234.98 460.00
2016-2018 2017 Governor's Amendments 14.50 14.50 29.00
2016-2018 2017 General Assembly Adjustments (7.50) (7.50) (15.00)
2016-2018 2018 Chapter 780, 2016 Appropriation Act 232.02 241.98 474.00
2016-2018 2018 Base Budget 225.02 234.98 460.00
2016-2018 2018 Governor's Amendments 14.50 14.50 29.00
2016-2018 2018 General Assembly Adjustments (7.50) (7.50) (15.00)
Operating Budget Addenda (in order of greatest impact)
•
Distribute savings to agency budgets Base Budget Adjustment
  Moves savings budgeted centrally in Paragraph A, Item 471.10, Chapter 665, 2015 Acts of Assembly from Central Appropriations to the individual budgets of state agencies.
 
  FY FY
General Fund ($3,385,235) ($3,385,235)
•
Adjust appropriation for centrally funded retirement rate changes Base Budget Adjustment
  Adjusts appropriation for changes in state employee retirement rates to 80 percent of the Virginia Retirement System Board certified rates budgeted in Central Appropriations, Item 467.H. of Chapter 665, 2015 Acts of Assembly. A companion adjustment provides funding to increase state employee retirement rates to 90 percent of the Virginia Retirement System Board certified rate.
 
  FY FY
General Fund $402,253 $402,253
Nongeneral Fund $433,189 $433,189
•
Adjust appropriation for the centrally funded two percent salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the two percent salary increase for state employees budgeted in Central Appropriations, Item 467.P. of Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund $277,577 $277,577
Nongeneral Fund $298,643 $298,643
•
Adjust appropriation to accelerate the employer retirement contribution phase in schedule Base Budget Adjustment
  Adjusts appropriation for changes in employee retirement rates to 90 percent of the Virginia Retirement System Board certified rate budgeted in Central Appropriations, Item 467.U. of Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund $220,451 $220,451
Nongeneral Fund $234,450 $234,450
•
Adjust appropriation for changes in information technology costs Base Budget Adjustment
  Adjusts appropriation for the changes in information technology costs budgeted in Central Appropriations, Items 468.M. and 470.B. of Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund ($219,206) ($219,206)
Nongeneral Fund ($230,817) ($230,817)
•
Adjust appropriation for the centrally funded compression pay adjustment for state employees Base Budget Adjustment
  Adjusts appropriation for the compression pay adjustment for state employees budgeted in Central Appropriations, Item 467.Q. of Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund $153,066 $153,066
Nongeneral Fund $164,681 $164,681
•
Adjust appropriation for centrally funded health insurance costs Base Budget Adjustment
  Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 467.G. of Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund $140,716 $140,716
Nongeneral Fund $147,848 $147,848
•
Adjust appropriation for centrally funded state employee other post employment benefit rate changes Base Budget Adjustment
  Adjusts appropriation for changes in state employee other post employment benefit rates budgeted in Central Appropriations, Item 467.K.3. of Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund $15,775 $15,775
Nongeneral Fund $16,988 $16,988
•
Adjust appropriation for the centrally funded increase in internal service fund costs due to salary adjustments Base Budget Adjustment
  Adjusts appropriation to agencies to offset increases in internal service fund costs due to the salary and benefit adjustments in Chapter 665, 2015 Acts of Assembly.
 
  FY FY
General Fund $6,880 $6,880
Nongeneral Fund $7,244 $7,244
•
Provide health care coverage to the uninsured Decision Package
  Authorizes the expansion of Medicaid on January 1, 2017, to non-elderly adults with incomes up to 133 percent of the federal poverty level. This action would result in over 350,000 Virginians gaining access to health care. In addition, the state would achieve significant savings as new Medicaid funding would supplant state-supported indigent care costs, services provided by Community Services Boards, and inpatient hospital costs for incarcerated individuals. The net general fund savings to the Commonwealth would be approximately $59.2 million in FY 2017 and $97.7 in FY 2018. This coverage expansion would reduce indigent care costs for hospitals across the Commonwealth, resulting in improvements to their financial condition, especially for rural hospitals.
 
  FY FY
General Fund ($38,564,934) ($46,001,617)
Nongeneral Fund $707,219,664 $2,297,021,490
Positions 15.00 15.00
•
Fund Medicaid utilization and inflation Decision Package
  Provides funding for the cost of Medicaid as estimated in the most recent forecast expenditures. Medicaid expenditures are projected to increase 3.8 percent in 2017 and 2.9 percent in 2018. Other than inflation and utilization growth, the major driver of the general fund need is a higher than expected number of low-income parents enrolling in the program.
 
  FY FY
General Fund $327,417,073 $461,668,747
Nongeneral Fund $330,359,928 $456,012,040
•
Replace federally mandated Medicaid enterprise claims system Decision Package
  Funds costs associated with replacing the existing Medicaid Management Information System (MMIS) and transforming to a Medicaid Enterprise System (MES). The MMIS is the mechanized claims processing and information retrieval system which states are required to have by the federal Centers for Medicare and Medicaid Services (CMS). The contract to operate Virginia’s MMIS ends June 30, 2018.
 
  FY FY
General Fund $4,635,000 $5,835,000
Nongeneral Fund $41,715,000 $52,515,000
•
Withhold biennial inflation for inpatient and outpatient hospitals Decision Package
  Eliminates the inflation adjustment in each year of the biennium (2.6 percent in FY 2017 and 2.7 percent in FY 2018) for hospital rates that is included in the Medicaid and children’s health insurance expenditure forecasts.
 
  FY FY
General Fund ($15,004,581) ($32,651,145)
Nongeneral Fund ($14,668,870) ($31,880,708)
•
Add waiver slots required by the Department of Justice settlement agreement Decision Package
  Adds a total of 855 new waiver slots to the intellectual and developmental disability waivers over the course of the biennium. These slots are mandated by the settlement agreement with the U.S. Department of Justice and include 180 slots for individuals transitioning out of facilities (90 in the first year and 90 in the second year), 50 slots to address the developemental disability waiver waitlist (25 in each year), and 625 slots to address the intellectual disability waiver waitlist (300 in the first year and 325 in the second year). The cost of each slot assumes the new rates and services proposed in a separate amendment to redesign the state's intellectual and developmental disability waivers.
 
  FY FY
General Fund $14,217,361 $31,758,543
Nongeneral Fund $14,217,361 $31,758,543
•
Increase ID/DD waiver rates and implement new ID/DD waiver services Decision Package
  Provides funds for the implementation of three redesigned Medicaid waivers serving individuals with intellectual and developmental disabilities. The costs include an average rate increase of 5.4 percent for waiver services, the addition of new services to assist in increasing the number of individuals who can live in integrated settings, an increase in the developmental disability case management rate, and additional funds for more intensive services for individuals who are medically fragile or have complex co-occuring behavioral health needs. The redesigned waivers will address the concerns raised by the U.S. Department of Justice (DOJ) and the U.S. District Court in relation to the state's compliance with the settlement agreement reached with the DOJ in 2012.
 
  FY FY
General Fund $13,154,660 $23,049,567
Nongeneral Fund $13,154,660 $23,049,567
•
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 savings is primarily a result of lower than expected managed care costs and a reduction in the state match requirement for the Children's Health Insurance Program grant.
 
  FY FY
General Fund ($14,578,588) ($14,179,780)
Nongeneral Fund ($21,084,476) ($18,159,887)
•
Rebase training center budgets to reflect anticipated closures Decision Package
  Adjusts the budget for state training center reimbursements to account for the on-going facility closure costs and savings resulting from compliance with the Department of Justice settlement agreement. This package reflects the estimated impact of closing Northern Virginia Training Center in March 2016, and Southwestern Virginia Training Center by the end of FY 2018. There is a companion amendment included in the Department of Behavioral Health and Developmental Services (DBHDS) training center Item to account for costs not reimbursable through Medicaid.
 
  FY FY
General Fund ($9,832,972) ($10,907,845)
Nongeneral Fund ($9,832,971) ($10,907,844)
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Health Care Fund to reflect the latest revenue estimates. Tobacco taxes are projected to increase by $2.2 million in FY 2017 and $2.7 million in FY 2018 based on the Department of Taxation's revised forecast. Conversely, Medicaid recoveries are expected to decline by $1.7 million in FY 2017 and $1.5 million in FY 2018. The estimates also assume that FY 2017 will begin with a $17.9 million prior year cash balance. 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 ($17,874,661) ($1,236,248)
Nongeneral Fund $17,874,661 $1,236,248
•
Increase personal care rates Decision Package
  Increases rates for consumer and agency directed personal care, respite care and companion care by two percent in FY 2017 in the Elderly or Disabled with Consumer Direction (EDCD) and ID/DD waivers and Early and Periodic Screening, Diagnosis and Treatment (ESPDT) program to cover provider expenses.
 
  FY FY
General Fund $7,124,799 $7,972,821
Nongeneral Fund $7,124,799 $7,972,821
•
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. This program applies to children between the ages of 6 through 19 with family income from 100 to 133 percent of the federal poverty level. The savings are largely attributable to a reduction in the state match for the Children's Health Insurance Program grant.
 
  FY FY
General Fund ($8,284,374) ($7,930,900)
Nongeneral Fund $4,879,077 $7,471,220
•
Transfer funds to support Hancock Geriatric Facility Decision Package
  Moves unused Medicaid match from the state facility program at the Department of Medical Assistance Services to the direct general fund appropriation at the Department of Behavioral Health and Developmental Services for the operation of Hancock Geriatric Facility. The facility lost Medicaid certification in FY 2016, and the decision to operate the facility as a general fund only facility requires the transfer of unused match to continue the operation of 80 beds in the facility. This amendment is a zero sum transfer between the two agencies.
 
  FY FY
General Fund ($6,640,991) ($6,640,991)
Nongeneral Fund ($6,640,991) ($6,640,991)
•
Withhold inflation from nursing facilities for FY 2018 Decision Package
  Eliminates the FY 2018 inflation adjustment for nursing facility rates that is included in the Medicaid expenditure forecast.
 
  FY FY
General Fund $0 ($12,713,641)
Nongeneral Fund $0 ($12,713,641)
•
Provide authority to limit overtime hours for consumer-directed attendants Decision Package
  Authorizes the Department of Medical Assistance Services (DMAS) to limit overtime hours that may be provided by attendants who are providing care under the consumer-directed service option in the Medicaid waivers. Funding for DMAS to comply with this new federal rule is included in the Official Consensus Medicaid forecast beginning in FY 2016.
 
  FY FY
General Fund ($5,700,000) ($6,200,000)
Nongeneral Fund ($5,700,000) ($6,200,000)
•
Fund comprehensive Medicaid benefit package for substance use disorder (SUD) treatment Decision Package
  Fund enhancements that are necessary to meet the Centers for Medicare and Medicaid Services (CMS) requirements for a comprehensive Medicaid benefit that would allow the Commonwealth to apply for a Substance Use Disorder (SUD) waiver. Specifically, this package includes funding and authority for the Department of Medical Assistance Services to expand substance abuse treatment coverage; increase Medicaid treatment rates; add peer support services; provide support for care coordination; and provide intensive provider education and recruitment. Funding and two positions are also included to cover the administrative costs associated with implementing this waiver.
 
  FY FY
General Fund $2,602,412 $8,376,260
Nongeneral Fund $2,602,412 $8,376,260
Positions 2.00 2.00
•
Implement the Managed Long-Term Services and Supports (MLTSS) initiative Decision Package
  Provides funding for five positions and adjusts the budget for anticipated management contract expenses associated with MLTSS start-up. The estimated savings represent the discontinuance of the current fee-for-service transportation contract as these services will move to managed care and will be incorporated into future payments. This package only reflects MLTSS administration and start-up adjustments. It is expected that the programmatic and service impact will be reflected in next year’s Medicaid forecast.
 
  FY FY
General Fund $551,953 ($7,776,547)
Nongeneral Fund $2,201,953 ($6,851,547)
Positions 5.00 5.00
•
Transfer central account funding to proper program Decision Package
  Moves general fund dollars, associated with central account distributions, from the Department of Behavioral Health and Developmental Services (DBHDS) to the Department of Medical Assistance Services (DMAS). A separate base adjustment provides DBHDS with central account funding associated with personnel services expenses incurred at Intellectual Disabilities Training Centers. However, much of the funding associated with the operation of these facilities comes from special fund revenue generated at DMAS in the form of Medicaid reimbursement, which requires a general fund match. Transferring this appropriation from DBHDS to DMAS places this funding where it is needed to generate the necessary operational revenue. This is a technical action with a companion package in agency 793.
 
  FY FY
General Fund $8,000,000 $8,000,000
•
Adjust Medicaid funding for Piedmont and Catawba Geriatric Hospitals Decision Package
  Increases the appropriation for Piedmont and Catawba Geriatric Hospitals to reflect the reversal of a prior budget amendment that assumed decreased Medicaid reimbursements due to the facilities being reclassified as intermediate care nursing homes. It has been determined that the facilities cannot meet the criteria for nursing home certification. A companion package included in the Department of Behavioral Health and Developmental Services removes the direct appropriation that was also provided.
 
  FY FY
General Fund $3,969,902 $3,969,902
Nongeneral Fund $3,969,902 $3,969,902
•
Cover increased cost of operational contracts Decision Package
  Provides funding to support the estimated cost of re-procuring several major contracts. The Department of Medical Assistance Services (DMAS) has three significant administrative contracts that will expire within the next year. Preliminary estimates indicate that the cost of these new contracts will be higher based on current market conditions.
 
  FY FY
General Fund $2,400,000 $2,400,000
Nongeneral Fund $2,400,000 $2,400,000
•
Fund reserve waiver slots Decision Package
  Funds 100 reserve waiver slots across three waivers: Intellectual Disability, Developmental Disability and Day Support waivers. Reserve slots will be used for emergencies, for individuals transferring between waivers and for individuals transitioning from an Intermediate Care Facility or nursing facility to the community in compliance with requirements of the 2012 Settlement with the U.S. Department of Justice. The cost of each slot assumes the new rates and services proposed in a separate amendment to redesign the state's intellectual and developmental disability waivers.
 
  FY FY
General Fund $1,886,913 $1,886,913
Nongeneral Fund $1,886,913 $1,886,913
•
Fund federally mandated 1095B notification mailing Decision Package
  Provides funding to support mailings and information referral activities as federally required by the Affordable Care Act (ACA) beginning January 1, 2016. The agency must print and mail proof of coverage (form 1095B) information to approximately 670,000 heads of households to enable those clients to complete their 2015 taxes. In addition, the agency is required to provide contact information to handle recipient questions. This package provides for the ongoing operational requirements; a separate package funds the initial costs in FY 2016.
 
  FY FY
General Fund $749,750 $749,750
Nongeneral Fund $1,500,250 $1,500,250
•
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 costs than previously estimated.
 
  FY FY
General Fund $1,786,293 $1,786,293
•
Increase private duty nursing rates Decision Package
  Increases rates for private duty nursing by two percent in the Tech waiver and Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program to cover a larger percentage of provider expenses.
 
  FY FY
General Fund $563,265 $656,490
Nongeneral Fund $563,265 $656,490
•
Cover Applied Behavioral Analysis (ABA) services under FAMIS Decision Package
  Adds coverage for Applied Behavioral Analysis (ABA), and other behavioral therapy services, for children in Family Access to Medical Insurance Security Plan (FAMIS). Virginia covers ABA and other behavioral therapy treatment services for children enrolled in Medicaid through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program but this option is not currently available to children in FAMIS.
 
  FY FY
General Fund $145,754 $121,793
Nongeneral Fund $675,393 $893,145
•
Correct prior action related to Third Party Liability (TPL) savings Decision Package
  Moves general fund savings, associated with adding staff to the Third Party Liability (TPL) recovery unit, to the correct program. The 2015 budget provided the recovery unit with additional positions and assumed that TPL recoveries would increase thereby creating a general fund savings. This technical adjustment properly accounts for the biennial savings with no net general fund impact.
 
  FY FY
Nongeneral Fund $848,573 $848,573
•
Increase support for managed care operations Decision Package
  Provides seven positions, and the associated funding, to handle the increased workload associated with the agency's complex and growing managed care enterprise. The additional positions will enhance managed care operations and Medallion 3.0 to ensure compliance with federal regulations.
 
  FY FY
General Fund $360,097 $360,097
Nongeneral Fund $360,097 $360,097
Positions 7.00 7.00
•
Withhold inflation from outpatient rehabilitation facilities for FY 2018 Decision Package
  Eliminates the FY 2018 inflation adjustment for outpatient rehabilitation facility rates that is included in the Medicaid expenditure forecast.
 
  FY FY
General Fund $0 ($170,394)
Nongeneral Fund $0 ($170,394)
•
Adjust appropriation for the costs of the new Cardinal financial system Decision Package
  Reflects the agency's share of the costs of the new Cardinal accounting system. The Department of Accounts allocates the yearly cost of the system to agencies based upon the number of transactions the agency completed in the previous fiscal year.
 
  FY FY
General Fund $71,842 $74,505
Nongeneral Fund $86,277 $89,485
•
Remove prior authorization for preventative lung cancer screenings Decision Package
  Provides funding to eliminate prior authorization requirements for low-dose computed tomography (LDCT) lung cancer screenings as a preventive measure for at-risk recipients. Based on current policy, LDCT screenings are only covered with prior authorization and when medically necessary. Covering the screening for Medicaid adults as a preventive service is expected to decrease a recipient’s risk of developing advanced-stage lung cancer.
 
  FY FY
General Fund $51,841 $59,325
Nongeneral Fund $51,841 $59,325
•
Withhold inflation from home health providers for FY 2018 Decision Package
  Eliminates the FY 2018 inflation adjustment for home health provider rates that is included in the Medicaid expenditure forecast.
 
  FY FY
General Fund $0 ($51,229)
Nongeneral Fund $0 ($51,229)
•
Adjust appropriation to support workers' compensation premiums Decision Package
  Supports the agency's workers' compensation premiums based on the allocation of program costs provided by the Department of Human Resource Management. The allocation is based on the historical experience of the agency and reflects the current policy of providing agencies with 50 percent of any increased costs and allowing agencies to retain 50 percent of any reduced costs.
 
  FY FY
General Fund $2,814 $3,049
Nongeneral Fund $3,889 $4,415
•
Continue operations of the Cover Virginia Centralized Processing Unit Decision Package
  Removes budget language in the Appropriation Act that restricts the capabilities of the Cover Virginia Centralized Processing Unit.
•
Develop prospective fiscal year rates for specialized care facilities Decision Package
  Authorizes the department to develop prospective state fiscal year rates for specialized care nursing facilities consistent with the existing cost-based methodology for specialized care nursing facilities.
•
Implement pricing methodology change for pharmaceutical products Decision Package
  Authorizes the department to implement a federally required pricing methodology change for pharmaceutical products. The Centers for Medicare and Medicaid Services (CMS) has issued final rules on pricing methodology for pharmaceuticals that will require states to pay pharmacies based on actual acquisition cost of the drug (ingredient) plus a professional dispensing fee. It is assumed that the required change will be implemented in a budget neutral fashion.
•
Move funding for forecasted Medicaid management contracts Decision Package
  Transfers funding for forecasted Medicaid management contracts to a new program. Four major contracts that vary based on the utilization of Medicaid are currently included in the annual forecasts and the budgets of Medicaid and children’s health insurance programs. This action moves these appropriations to a separate program that allows for greater transparency and will simply the administrative oversight. The technical package nets to zero and has no impact on spending.
•
Eliminate Medicaid Expansion General Assembly Adjustment
  This amendment adds appropriation to offset the savings and costs included in the introduced budget as a result of the proposal to expand Medicaid. The costs of a Medicaid expansion, including the nongeneral fund costs, are eliminated. All appropriations in the budget are contingent upon not expanding the Medicaid program pursuant to the Patient Protection and Affordable Care Act.
 
  FY FY
General Fund $49,840,150 $59,720,902
Nongeneral Fund ($676,905,173) ($2,266,002,203)
•
Eliminate Administrative Funding for Medicaid Expansion General Assembly Adjustment
  This amendment eliminates funding provided for the administrative costs of the agency to implement an expansion of Medicaid. In separate budget action the expansion is removed and this amendment reflects that action.
 
  FY FY
General Fund ($11,759,798) ($15,173,158)
Nongeneral Fund ($30,314,491) ($31,019,287)
Positions (15.00) (15.00)
•
Capture Savings from Moratorium on ACA Health Insurance Tax General Assembly Adjustment
  This amendment eliminates $25.7 million from the general fund and $25.7 million in matching federal Medicaid funds the second year contained in the Medicaid forecast that was included to pay the health insurance tax on managed care contracts as required by the Patient Protection and Affordable Care Act. The Consolidated Appropriations Act of 2016 placed a moratorium on this tax for 2017, which results in a savings in the amount paid by the Department of Medical Assistance Services in fiscal year 2018.
 
  FY FY
General Fund $0 ($25,956,371)
Nongeneral Fund $0 ($25,956,371)
•
Reverse Federal Action on Overtime for Consumer-Directed Attendants General Assembly Adjustment
  This amendment eliminates $8.4 million the first year and $10.5 million the second year from the general fund and language contained in the introduced budget to authorize the payment of overtime for Medicaid-reimbursed consumer-directed (CD) personal assistance, respite and companion services for a single attendant who works more than 40 hours per week. Language is added to require the Department of Medical Assistance Services to amend the State Plan for Medical Assistance to reflect that no authority is provided to authorize overtime for Medicaid-reimbursed CD personal assistance, respite and companion services and to allow the agency to implement emergency regulations to effect the change.
 
  FY FY
General Fund ($8,385,666) ($10,538,077)
Nongeneral Fund ($8,385,666) ($10,538,077)
•
Restore Partial Inflation for Hospitals in FY 2017 General Assembly Adjustment
  This amendment restores funding to provide a 1.3 percent inflation adjustment for hospitals in fiscal year 2017. The introduced budget eliminated hospital inflation in both years on the rationale that a Medicaid expansion would financially benefit hospitals to a greater extent than hospital inflation. However, companion amendments eliminate Medicaid expansion. Language corrects the general fund appropriation for the two state teaching hospitals based on the funding provided in this amendment.
 
  FY FY
General Fund $7,185,612 $8,262,228
Nongeneral Fund $7,325,333 $8,418,665
•
Add 355 Waiver Slots General Assembly Adjustment
  This amendment provides $5.2 million the first year and $5.2 million the second year from the general fund and a like amount of federal Medicaid matching funds to add up to a total of 355 waiver slots in fiscal year 2017. Of these slots, 200 are provided for individuals at the top of the Developmental Disability (DD) waiver chronological waiting list as of June 30, 2016, and an additional 115 DD slots are added to the 25 slots included in the introduced budget. Up to 40 emergency reserve slots may be created across the Intellectual Disability, Developmental Disability, and Day Support waivers in fiscal year 2017 for emergencies, for individuals transferring between waivers and for individuals transitioning from an Intermediate Care Facility (ICF) or state nursing facility (SNF) to the community to ensure the health and safety of individuals in crisis.
 
  FY FY
General Fund $5,227,438 $5,227,438
Nongeneral Fund $5,227,438 $5,227,438
•
Restore Partial Inflation for Nursing Facilities in FY 2018 General Assembly Adjustment
  This amendment provides $6.4 million from the general fund and a corresponding amount of federal matching funds to provide an inflation adjustment of 1.45 percent in fiscal year 2018. The introduced budget had eliminated an inflation adjustment for nursing facilities in the second year.
 
  FY FY
General Fund $0 $6,356,821
Nongeneral Fund $0 $6,356,821
•
Restore Inflation Calculation Affecting Future Nursing Facility Rebasing General Assembly Adjustment
  This amendment modifies languages in the introduced budget to clarify that the deferral of an inflation adjustment for nursing facility rates in fiscal year 2016 was not intended to affect any future rebasing of nursing facility rates. The Department of Medical Assistance Services has interpreted the language as a perpetual deferral and this language corrects that interpretation. The deferral of the fiscal year 2016 inflation adjustment continues to affect the first year of the biennium; but the second year rates, under a scheduled rebasing, would not be affected by the 2016 deferral.
 
  FY FY
General Fund $0 $5,578,840
Nongeneral Fund $0 $5,578,840
•
Expand Eligibility to 80% for Waiver Svs. for Seriously Mentally Ill General Assembly Adjustment
  This amendment adds $1.6 million the first year and $3.8 million the second year from the general fund and a like amount of federal matching Medicaid funds to modify the income eligibility criteria for the Medicaid demonstration waiver program for adults with serious mental illness in Medicaid from 60 to 80 percent of the federal poverty level. 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.
 
  FY FY
General Fund $1,629,813 $3,782,618
Nongeneral Fund $1,629,813 $3,782,618
•
Eliminate Reserve Waiver Slots General Assembly Adjustment
  This amendment eliminates $1.9 million each year from the general fund with a corresponding reduction in federal funds for 100 reserve waiver slots. A companion amendment in this item provides funding for 40 emergency reserve waiver slots.
 
  FY FY
General Fund ($1,886,913) ($1,886,913)
Nongeneral Fund ($1,886,913) ($1,886,913)
•
Reduce Funding for Administrative Contracts General Assembly Adjustment
  This amendment reduces funding of $1.2 million the first year and $800,000 the second year from the general fund and a corresponding amount of federal matching funds for administrative contract increases. The introduced budget included $2.4 million each year to cover the expected increase in costs of three administrative contracts: an enrollment broker, actuary and audit contract. The enrollment broker contract was awarded and took effect January 1, 2016, and funding of $800,000 each year is provided for this purpose. The other two contracts are not yet awarded and will take effect January 1, 2017. This amendment reduces the remaining funds by half for the two contracts yet to be awarded, leaving $400,000 the first year and $800,000 the second year. Since the increased costs of such contracts are not known, it is premature to add full funding.
 
  FY FY
General Fund ($1,200,000) ($800,000)
Nongeneral Fund ($1,200,000) ($800,000)
•
Restore FY 2017 Inflation for CHKD General Assembly Adjustment
  This amendment provides $633,358 the first year and $726,894 the second year with a corresponding amount of federal matching funds to fully restore the inflation increase of 2.6 percent in fiscal year 2017 for Children's Hospital of The King's Daughters (CHKD). The introduced budget eliminated inflation for all hospitals in fiscal year 2017 and fiscal year 2018. A separate amendment provides an inflation adjustment of 1.3 percent for other hospitals in fiscal year 2017.
 
  FY FY
General Fund $633,358 $726,894
Nongeneral Fund $633,358 $726,894
•
Eliminate Unecessary Funding for Medicaid Support of ConnectVirginia General Assembly Adjustment
  This amendment eliminates $250,000 each year from the general fund and $1.1 million in federal matching funds that were originally appropriated to support Medicaid's share of the Commonwealth Health Information Exchange and to provide support for providers to join. However, the state has not received federal approval to make these payments and the funding is not currently needed.
 
  FY FY
General Fund ($250,000) ($250,000)
Nongeneral Fund ($1,050,000) ($1,050,000)
•
Fund Medical Residencies through Medicaid General Assembly Adjustment
  This amendment provides $1.3 million from the general fund and an equivalent amount of federal matching funds the second year to increase the number of medical residency slots funded through Medicaid. The average residency slot is estimated at $100,000 a year and this funding would create 25 the second year. Half of the slots would be dedicated to primary care and the remainder for high-need specialties. Preference will be given to residency programs in community and rural areas that are underserved. This is a Joint Commission on Health Care recommendation.
 
  FY FY
General Fund $0 $1,250,000
Nongeneral Fund $0 $1,250,000
•
Equalize Rates for Private Duty Nursing in Medicaid General Assembly Adjustment
  This amendment adjusts the Medicaid rate increase for private duty nursing in the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program and Assistive Technology (TECH) waiver to 11.5 percent to match the increase for private duty nursing in the intellectual and developmental disability (I/DD) waivers. A separate budget amendment for the Intellectual Disability and Developmental Disability waivers reflects a rate that is equal to the 11.5 percent rate increase for EPSDT and the TECH waiver. Medicaid rates for private duty nursing in the TECH waiver and the EPSDT program cover a larger percentage of provider expenses and should match the rates paid in the Medicaid waivers. The introduced budget includes a two percent increase for nursing rates in the EPSDT program and the TECH waiver while the rates in the I/DD waiver were proposed to increase 40 percent. This amendment reallocates the total funding for all the rate changes and equalizes the increase across Medicaid programs that provide private duty nursing.
 
  FY FY
General Fund $600,000 $600,000
Nongeneral Fund $600,000 $600,000
•
Capture Hospital Rebasing Savings from FAMIS Program General Assembly Adjustment
  This amendment reduces funding by $117,750 the first year and $133,925 the second year from the general fund and $863,504 the first year and $982,118 the second year from Medicaid matching funds for the Family Access to Medical Insurance Security (FAMIS) program. Hospital rates are rebased every three years to ensure the prospective rate methodology is based on the most recent cost information. The latest rebasing calculations reflect a rate reduction. The introduced budget reflected savings in the Medicaid program but not the other medical assistance programs that are also impacted.
 
  FY FY
General Fund ($117,750) ($133,925)
Nongeneral Fund ($863,504) ($982,118)
•
Restore Involuntary Mental Commitment Funding Reflecting Reversal of Medicaid Expansion General Assembly Adjustment
  This amendment restores $484,582 the first year and $1.5 million the second year from the general fund for the medical costs associated with involuntary mental commitments to reflect the reversal of the expansion of Medicaid that was included in the introduced budget.
 
  FY FY
General Fund $484,582 $1,453,873
•
Capture Hospital Rebasing Savings - Medicaid CHIP Program General Assembly Adjustment
  This amendment reduces funding by $106,922 the first year and $123,901 the second year from the general fund and $784,092 the first year and $908,606 the second year from Medicaid matching funds for the Medicaid Children's Health Insurance Program to reflect lower hospital rates based on the rebasing methodology. Hospital rates are rebased every three years to ensure the prospective rate methodology is based on more current cost information. The latest rebasing calculations reflect a rate reduction. The introduced budget reflected savings in the Medicaid program but not the other medical assistance programs that are also impacted.
 
  FY FY
General Fund ($106,922) ($123,901)
Nongeneral Fund ($784,092) ($908,606)
•
Modify ID/DD Waiver Redesign General Assembly Adjustment
  This amendment adds funding and modifies language for the proposed rate changes and new services as part of the redesign of the Individual and Family Developmental Disabilities Support (DD), Day Support (DS), and Intellectual Disability (ID) Waivers. The language clarifies that the rate change for skilled nursing shall be a 25 percent increase and that private duty nursing rates shall be equal to the rates in the Assistive Technology and Early and Periodic Screening, Diagnostic, Treatment program. Funding is reduced by $200,000 from the general fund and $200,000 from nongeneral funds the first year to defer some of the proposed less critical new services for the intellectual and developmental disability (I/DD) waiver redesign until the second year. This deferral will ensure that the agencies are able to implement three new I/DD waiver programs efficiently and effectively, providing the most critical new services first while continuing to increase the number of waiver slots required pursuant to the U.S. Department of Justice Settlement Agreement and the additional waiver slots provided during the 2016 Session of the General Assembly. In addition, this amendment provides $328,452 the first year and $656,903 the second year from the general fund and a corresponding increase in federal Medicaid matching funds for providing a rate differential in the family home payment for Northern Virginia providers of Sponsored Residential services. As part of the redesign of the Intellectual and Developmental Disability waivers the rate increases proposed by the consultant did not take into account such a differential for this service.
 
  FY FY
General Fund $128,452 $656,903
Nongeneral Fund $128,452 $656,903
•
Adjust Revenue for the Virginia Health Care Fund General Assembly Adjustment
  This amendment reduces the general fund appropriation for Medicaid by $361,659 the first year and $361,659 the second year and increases a like amount of nongeneral funds each year, reflecting increased revenues to the Virginia Health Care Fund (VHCF). Because revenues to the fund have historically been used as the state share of Medicaid, additional revenue results in an equal amount of general fund savings. Current estimates of cigarette tax collections indicate that Virginia will receive slightly more revenue than was assumed in the introduced budget. This additional revenue, which is deposited into the Virginia Health Care Fund, allows for a reduction in general fund appropriations for the state's share of Medicaid funding.
 
  FY FY
General Fund ($361,659) ($361,659)
Nongeneral Fund $361,659 $361,659
•
Eliminate Ongoing Call Center Costs for Insurance Notifications General Assembly Adjustment
  This amendment removes $340,900 from the general fund and $1.1 million from federal matching funds the second year in the introduced budget for the ongoing costs of the CoverVirginia call center related to an expected increase in call volume from Medicaid enrollees receiving notifications on insurance. The Affordable Care Act requires that individuals be notified by insurers of their insurance status during the year. Beginning in 2016, state Medicaid programs are required to send out these notices. Call volumes are uncertain at this point and this amendment funds the contract in the first year only, until additional information on the real impact is determined and the ongoing costs are known.
 
  FY FY
General Fund $0 ($340,900)
Nongeneral Fund $0 ($1,059,100)
•
Increase Payment Rate by 15% for Nursing Homes with Special Populations General Assembly Adjustment
  This amendment adds funding and language in the second year to change the reimbursement methodology for nursing facilities that provide services to a resident population in which at least 80 percent of the residents have specific chronic and disabling conditions and the facility has at least a 90 percent Medicaid utilization and a case mix index of 1.15 or higher in fiscal year 2017. These conditions tend to occur in a younger population who consequently have a significantly longer stay in a nursing facility than many nursing home residents. Consequently, the costs to serve these individuals is much higher. Currently, only one nursing facility, the Virginia Home, would meet the criteria to qualify for additional funding pursuant to the reimbursement methodology change.
 
  FY FY
General Fund $0 $619,511
Nongeneral Fund $0 $619,511
•
Physician Supplemental Payments for Children's National Health System General Assembly Adjustment
  This amendment provides $275,500 each year from the general fund and a corresponding increase in federal matching funds for Children's National Health System to address critical workforce development needs as the region's premier teaching hospital for pediatrics and helps bridge the gap between the pediatric Medicaid rate paid by Virginia to Children's and the Medicare rates.
 
  FY FY
General Fund $275,500 $275,500
Nongeneral Fund $275,500 $275,500
•
Capture Hospital Rebasing Savings from Involuntary Mental Commitments General Assembly Adjustment
  This amendment reduces funding by $452,277 the first year and $522,046 the second year from the general fund for medical services of involuntary mental commitments. Hospital rates are rebased every three years to ensure the prospective rate methodology is based on the most recent cost information. The latest rebasing calculations reflect a rate reduction. The introduced budget reflected savings in the Medicaid program but not the other medical assistance programs that are also impacted.
 
  FY FY
General Fund ($452,277) ($522,046)
•
Increase Adult Day Health Care Rates by 2.5 Percent General Assembly Adjustment
  This amendment adds funds to provide a 2.5 percent increase in the Medicaid waiver reimbursement rate for adult day health services. Adult day health care is much less expensive than alternative care in a nursing facility for which these clients qualify. Providers of adult day health care report a gap of $18.13 per client per day between actual costs and Medicaid reimbursement, which must be made up through contributions from individuals, churches, corporations, and foundations. These services are almost exclusively provided to Medicaid waiver recipients. This amendment will increase the statewide rate paid for Medicaid adult day health care services from $60.10/unit to $61.60/unit in Northern Virginia and from $55.65/unit to $57.04/unit in the rest of the state. A 'unit' represents 6 or more hours in a day.
 
  FY FY
General Fund $79,505 $87,581
Nongeneral Fund $79,505 $87,581
•
Restore Partial Inflation for Home Health and Outpatient Rehab in FY 2018 General Assembly Adjustment
  This amendment provides $110,812 the second year and a corresponding amount of federal matching funds to provide a 1.6 percent inflation adjustment for home health agencies and a 1.45 percent inflation adjustment for outpatient rehabilitation agencies. Funding for an inflation adjustment in the second year was removed in the introduced budget.
 
  FY FY
General Fund $0 $110,812
Nongeneral Fund $0 $110,812
•
Technical-Adjust Appropriation for Applied Behavioral Analysis (ABA) Services General Assembly Adjustment
  This amendment accounts for a slightly higher federal match rate for Applied Behavioral Analysis (ABA) services in fiscal year 2017. The introduced budget adds coverage for ABA and other behavioral therapy services for children in FAMIS. The federal match rate for fiscal year 2017 was assumed to be approximately 82 percent; however, the federal government will cover 88 percent of costs. In addition, authorizing language included in Item 306 LLLL of the budget bill is moved to this item.
 
  FY FY
General Fund ($47,216) $0
Nongeneral Fund $47,216 $0
•
Clarify Waiver Authority and Reporting Requirements General Assembly Adjustment
  This amendment provides clarity and transparency with regard to waivers of Medicaid rules as allowed by the Social Security Act. The language provides that any waiver application requires, prior to submission, advance notice to the Chairmen of the House Appropriations and Senate Finance Committees and provides a 30-day period for any objections or concerns to be raised. If an objection is raised, then the waiver application must be requested through the normal legislative process, otherwise the agency may proceed with the waiver application.
•
Delivery System Reform Incentive Program Implementation General Assembly Adjustment
  This amendment provides that if a Delivery System Reform Incentive Program is approved for Virginia, the General Assembly shall have an opportunity to consider the program in the 2017 Session and provides for notification of the waiver agreement with the CMS.
•
DMAS Analysis of Pharmacy Claims General Assembly Adjustment
  This amendment adds language requiring the Director of the Department of Medical Assistance Services (DMAS) to analyze pharmacy claims data to identify the difference in the value of payments made to contracted Medicaid managed care plans and the value of payments made by the contracted managed care plans to their contracted prescription benefit managers (PBMs). Further, the Director of DMAS is directed to request, and if available, analyze the value of the program's managed care plans contracted PBMs to network pharmacies. The Director of DMAS is directed to identify and report any payment differences and make recommendations to the Chairmen of the House Appropriations Committee and Senate Finance Committees by October 1, 2016.
•
DMAS GAP Outreach to DOC & Local Jails General Assembly Adjustment
  This amendment adds language to require the Department of Medical Assistance Services to provide information and conduct outreach activities with the Department of Corrections and local and regional jails on the GAP program to provide Medicaid primary care, outpatient services, medications and mental health services to low-income individuals with serious mental illness who are released from custody.
•
DMAS Report on Eligible but Unenrolled General Assembly Adjustment
  This amendment adds language requiring a report on the estimated number of Virginians who are eligible but not enrolled in the Virginia Medicaid program.
•
Improve Medicaid Eligibility Policy and Procedures General Assembly Adjustment
  This amendment adds language to require the Department of Medical Assistance Services (DMAS) to implement provisions to improve the current Medicaid eligibility policy and procedures based on a recent Joint Legislative Audit and Review Commission report on Medicaid eligibility determination. The department must require all Medicaid eligibility workers to apply the same protocols when verifying income for all applicants and recipients, including those who report no earned or unearned income, by October 1, 2017. A companion amendment in Item 350 provides one-time funding to cover the costs of the change to the eligibility system.
•
Improve Public Access to Medicaid Data General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to include more data and statistical information regarding its programs on a central website to make the data more easily accessible and available to the general public.
•
Medicaid Asset Recovery Program General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to develop a plan for an improved Medicaid estate recovery program and requires that eligibility workers search for unreported assets with currently available data. This amendment is based on recommendations from JLARC's review of Medicaid eligibility determination.
•
Medicaid Forecasting Process General Assembly Adjustment
  This amendment establishes greater detail and clarity on the Medicaid forecasting process. These changes will improve transparency and ensure integrity of the process. The Medicaid program is a significant driver of state spending and therefore any estimates of program spending are essential to the state budget process.
•
Medicaid Physician & Managed Care Liaison Comm. - ER Care Coordination Workgroup General Assembly Adjustment
  This amendment adds language directing the Medicaid Physician and Managed Care Liaison Committee to review certain issues affecting the provision of Medicaid services, including how to improve care of 'super utilizers', the impact of primary care provider incentive funding on improved interoperability between hospital and provider systems, and the use of best practices for Emergency Departments to improve care and treatment of Medicaid clients and improve cost efficiency.
•
Medicaid Resource Eligibility Change General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to seek federal authority to use an alternative methodology for valuing real property for the purpose of determining resources of a Medicaid applicant.
•
Modify Substance Use Disorder Language and Notification General Assembly Adjustment
  This amendment modifies implementation details and adds a notification requirement for the Substance Use Disorder plan, which was included in the introduced budget.
•
Move Applied Behavioral Analysis Language to Correct Item General Assembly Adjustment
  This amendment moves language authorizing Applied Behavioral Analysis (ABA) coverage for FAMIS children. A separate amendment adds the language back in the item where the associated funding is appropriated.
•
Move central account funding to correct service area General Assembly Adjustment
  Moves general fund dollars, associated with central account distributions for the Department of Behavioral Health and Developmental Services (DBHDS), to the correct service area in Department of Medical Assistance Services (DMAS).
•
Specify Appropriation for Medicaid Enterprise System in Language General Assembly Adjustment
  This amendment includes in budget language information regarding the amount of funding that has been appropriated for the replacement of the Medicaid Management Information System. Due to the size of the project and the multi-year time-frame, it is useful to include such information in budget language to track the funding for the project. In addition, the language requires reporting of information about the contract award and ongoing project status updates.
•
Workgroup on Brain Injury Data and Out-of-State Services General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to convene a workgroup to recommend improvements to data collection on the incidence of brain injury and to review expenditures on Virginians with brain injury receiving care outside of the state.
•
Workgroup on the Alzheimer's Assisted Living Waiver General Assembly Adjustment
  This amendment adds language to require the Department of Medical Assistance Services to convene a work group to review the Alzheimer's Assisted Living Waiver to determine if it can be modified to comply with federal rule changes. The agency is required to create a plan if the waiver cannot be modified to ensure continuity of services for individuals currently on the waiver and make recommendations to the Governor and Chairmen of the House Appropriations and Senate Finance Committees by October 1, 2016.


p3_bullets - Official Enacted Budget - 10-07-2025 04:50:11