| • |
|
| |
Adjusts appropriation for the three percent salary increase for state employees budgeted in Central Appropriations, Item 475 X. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$1,694,025 |
$1,694,025 |
| Nongeneral Fund |
$1,749,678 |
$1,749,678 |
|
| • |
|
| |
Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 475 G. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$1,469,264 |
$1,469,264 |
| Nongeneral Fund |
$1,506,557 |
$1,506,557 |
|
| • |
|
| |
Adjusts appropriation for changes in information technology and telecommunications usage budgeted in Central Appropriations, Item 476 G. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$73,725 |
$73,725 |
| Nongeneral Fund |
$658,403 |
$658,403 |
|
| • |
|
| |
Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 475 G. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
($331,956) |
($331,956) |
| Nongeneral Fund |
($342,860) |
($342,860) |
|
| • |
|
| |
Adjusts appropriation for the two percent salary increase for state employees in high turnover job roles budgeted in Central Appropriations, Item 475 BB. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$255,956 |
$255,956 |
| Nongeneral Fund |
$255,956 |
$255,956 |
|
| • |
|
| |
Adjusts appropriation for information technology auditors and information security officers budgeted in Central Appropriations, Item 476 J. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$141,447 |
$141,447 |
| Nongeneral Fund |
$157,955 |
$157,955 |
|
| • |
|
| |
Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 475 V. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
($133,860) |
($133,860) |
| Nongeneral Fund |
($134,245) |
($134,245) |
|
| • |
|
| |
Adjusts appropriation for changes in state employee other post-employment benefit rates budgeted in Central Appropriations, Item 475 K. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$109,138 |
$109,138 |
| Nongeneral Fund |
$112,723 |
$112,723 |
|
| • |
|
| |
Adjusts appropriation for the Personnel Management Information System internal service fund charges budgeted in Central Appropriations, Item 476 O. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
$4,178 |
$4,178 |
| Nongeneral Fund |
$4,684 |
$4,684 |
|
| • |
|
| |
Adjusts appropriation for the reduction in Cardinal charges budgeted in Central Appropriations, Item 476 L. of Chapter 836, 2017 Acts of Assembly. |
| |
| |
FY |
FY |
| General Fund |
($1,064) |
($1,064) |
| Nongeneral Fund |
($1,282) |
($1,282) |
|
| • |
|
| |
Authorizes the expansion of Medicaid on October 1, 2018, to non-elderly adults with incomes up to 133 percent of the federal poverty level. This action results in over 300,000 Virginians gaining access to health care. This coverage expansion will reduce indigent care costs for hospitals across the Commonwealth, resulting in improvements to their financial condition, especially for rural hospitals. As such, the cost of this expansion will be covered by an assessment on the net patient revenue of private acute care hospitals operating in Virginia. This proposed expansion of Medicaid will allow Virginia to achieve significant savings as new Medicaid funding will supplant state-supported indigent care costs, services provided by Community Services Boards, and inpatient hospital costs for incarcerated individuals. The estimated general fund savings to the Commonwealth is approximately $152.0 million in FY 2019 and $269.7 million in FY 2020. CHAR(13) + CHAR(10) |
| |
| |
FY |
FY |
| General Fund |
($120,384,883) |
($221,410,214) |
| Nongeneral Fund |
$926,114,992 |
$2,236,379,476 |
| Positions |
15.00 |
15.00 |
|
| • |
|
| |
Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent forecast expenditures. |
| |
| |
FY |
FY |
| General Fund |
$199,450,674 |
$384,421,932 |
| Nongeneral Fund |
$334,394,964 |
$498,099,289 |
|
| • |
|
| |
Adds a total of 825 new waiver slots to the Community Living (CL) and Family and Individual Supports (FIS) waivers over the course of the biennium. These slots are mandated by the settlement agreement with the U.S. Department of Justice and include 70 slots for individuals transitioning out of facilities (35 in the each year), 75 slots to address the FIS waiver waitlist (25 in the first year and 50 in the second year), and 680 slots to address the CL waiver waitlist (325 in the first year and 355 in the second year). |
| |
| |
FY |
FY |
| General Fund |
$14,504,043 |
$30,515,895 |
| Nongeneral Fund |
$14,504,043 |
$30,515,895 |
|
| • |
|
| |
Adjusts funding for utilization and inflation in the Family Access to Medical Insurance Security (FAMIS) program based on the most recent forecast of expenditures. Funding assumes that current enhanced federal match (88 percent) is maintained for federal fiscal years 2018 and 2019. In federal fiscal year 2020, it is expected that the federal match rate for Virginia will drop to 76.5 percent. |
| |
| |
FY |
FY |
| General Fund |
$3,849,858 |
$23,399,128 |
| Nongeneral Fund |
$28,232,295 |
$19,253,975 |
|
| • |
|
| |
Amends funding provided, in a separate package, for the November 2017 forecast of Medicaid expenditures to fully fund the cost of a federal tax imposed on health plans. In addition, funding is removed to account for an annual transfer of general fund from the Children's Services Act (CSA) to support services provided to CSA children. |
| |
| |
FY |
FY |
| General Fund |
($22,426,441) |
$14,377,085 |
| Nongeneral Fund |
($22,426,441) |
$14,377,085 |
|
| • |
|
| |
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 action represents the projected training center savings, which are based on the anticipated discharge schedules for the Central Virginia Training Center (CVTC) and Southwestern Virginia Training Center (SWVTC) and the associated direct and indirect costs. There is a companion amendment included in the Department of Behavioral Health and Developmental Services training center Item to account for costs not reimbursable through Medicaid. |
| |
| |
FY |
FY |
| General Fund |
($10,547,486) |
($17,036,146) |
| Nongeneral Fund |
($10,547,486) |
($17,036,146) |
|
| • |
|
| |
Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Tobacco taxes are projected to decrease by $10.1 million in FY 2019 and $10.8 million in FY 2020 based on the Department of Taxation's revised forecast. Conversely, Medicaid recoveries are expected to increase by $22.3 million in FY 2019 and $17.3 million in FY 2020. Since the Health Care 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 |
($12,220,660) |
($6,520,660) |
| Nongeneral Fund |
$12,220,660 |
$6,520,660 |
|
| • |
|
| |
Adjusts funding for the Commonwealth's Medicaid Children's Health Insurance Program to reflect the latest expenditure forecast. Funding assumes that current enhanced federal match (88 percent) is maintained for federal fiscal years 2018 and 2019. In federal fiscal year 2020, it is expected that the federal match rate for Virginia will drop to 76.5 percent. |
| |
| |
FY |
FY |
| General Fund |
$1,921,446 |
$16,615,995 |
| Nongeneral Fund |
$14,090,604 |
$4,571,074 |
|
| • |
|
| |
Adjusts federal appropriation to reflect anticipated grant revenue from the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. Entirely supported with federal dollars, the EHR incentive program is in its final program years with payments ending in 2021. |
| |
| |
FY |
FY |
| Nongeneral Fund |
($16,000,000) |
($16,000,000) |
|
| • |
|
| |
Increases rates for consumer directed personal, respite, and companion care services by two percent in the home and community based services waivers and Early Periodic Screening, and Diagnosis and Treatment program (EPSDT) program to cover provider expenses. |
| |
| |
FY |
FY |
| General Fund |
$4,773,196 |
$5,055,102 |
| Nongeneral Fund |
$4,773,196 |
$5,055,102 |
|
| • |
|
| |
Authorizes the Department of Medical Assistance Services (DMAS), beginning July 1, 2019, 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 16 hours for a single attendant who works more than 40 hours per week. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$9,609,223 |
| Nongeneral Fund |
$0 |
$9,609,223 |
|
| • |
|
| |
Funds the anticipated increased costs associated with re-procuring the Cover Virginia Call Center. The current Cover Virginia contract, which includes a statewide call center, MAGI eligibility determination unit, and the GAP program unit, ends June 30, 2018. DMAS expects to request an extension of this contract for the period July 1, 2018 for one additional year ending June 30, 2019, the maximum allowable extension. The funding provided in this package will ensure continuity of operations through the new performance period. |
| |
| |
FY |
FY |
| General Fund |
$3,750,000 |
$1,125,000 |
| Nongeneral Fund |
$6,250,000 |
$3,375,000 |
|
| • |
|
| |
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 |
$3,022,906 |
$3,935,262 |
|
| • |
|
| |
Covers the Medicaid costs associated with completing the implementation of same day access at all Community Service Boards (CSB) effective July 1, 2019. The budget adopted by the 2016 General Assembly included funds to cover the Medicaid cost of providing same day access at 18 of the 40 CSBs in Virginia beginning July 1, 2017. This funding will support the costs in the remaining 22 CSBs. |
| |
| |
FY |
FY |
| General Fund |
$1,600,000 |
$1,600,000 |
| Nongeneral Fund |
$1,600,000 |
$1,600,000 |
|
| • |
|
| |
Funds 50 community living (CL) waiver slots (25 in each year) that will be held as reserve capacity by the Department of Behavioral Health and Disability Services (DBHDS). This capacity will allow DBHDS to address unanticipated emergency situations, such as accommodating community transition of institutionalized individuals, transitioning between waivers, and serving individuals in a crisis situation. |
| |
| |
FY |
FY |
| General Fund |
$937,238 |
$1,874,475 |
| Nongeneral Fund |
$937,238 |
$1,874,475 |
|
| • |
|
| |
Funds a contract with an independent External Quality Review Organization (EQRO) to conduct an external quality review of the department's contracted managed care organizations (MCO). EQRO activities include the analysis and evaluation of aggregated information on quality, timeliness, and access to the health care services that MCOs furnish to Medicaid recipients. This package also supports an audit of each MCO's network to ensure enrollees have adequate access to services. This funding ensures that the Commonwealth’s managed care programs (Commonwealth Coordinated Care Plus and Medallion 4.0) are fully compliant with final federal regulations. |
| |
| |
FY |
FY |
| General Fund |
$301,755 |
$570,449 |
| Nongeneral Fund |
$905,266 |
$1,711,348 |
|
| • |
|
| |
Reduces the appropriation (general fund and federal) that is used to provide Disproportionate Share Hospital (DSH) payments to two behavioral health facilities (Piedmont Geriatric Hospital and Catawba Hospital) operated by the Department of Behavioral Health and Developmental Services. DSH payments are made to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. The Patient Protection and Affordable Care Act (ACA, P. L. 111-148 as amended) reduces DSH funding to all states beginning in federal FY 2018 (cuts were originally supposed to begin in FY 2014 but have been delayed). As such, it is expected that the payments (total funds) to Piedmont and Catawba will be reduced $907,820 in FY 2019 and $1,270,948 in FY 2020 (half of these amounts are general fund). |
| |
| |
FY |
FY |
| General Fund |
($453,910) |
($635,474) |
| Nongeneral Fund |
($453,910) |
($635,474) |
|
| • |
|
| |
Funds training for consumer-directed attendants who provide personal assistance, respite, and companion services. |
| |
| |
FY |
FY |
| General Fund |
$500,000 |
$500,000 |
| Nongeneral Fund |
$500,000 |
$500,000 |
|
| • |
|
| |
Appropriates revenue generated from Civil Money Penalties (CMP) to support additional activities as approved by the Centers for Medicare and Medicaid Services. CMPs are sanctions collected from nursing facilities for being out of compliance with federal long term care requirements. A portion of these penalties are retained by Virginia to address emergency situations and support activities that benefit nursing facility residents. |
| |
| |
FY |
FY |
| Nongeneral Fund |
$700,000 |
$700,000 |
|
| • |
|
| |
Authorizes the agency to partner with Vision to Learn, a non-profit organization, to provide vision exams and corrective lenses and frames to school age children enrolled in Title I schools where at least 51 percent of the student body qualifies for free or reduced lunch. The agency is further authorized to use local public and private contributions to match federal funds through the Children’s Health Insurance Program (CHIP) Health Services Initiative. |
| |
| |
FY |
FY |
| Nongeneral Fund |
$336,096 |
$336,096 |
|
| • |
|
| |
Provides funding to address data security weaknesses by adding two new positions with experience in risk management, encryption key management, intrusion protection and detection, and vulnerability scanning. |
| |
| |
FY |
FY |
| General Fund |
$138,087 |
$138,087 |
| Nongeneral Fund |
$138,087 |
$138,087 |
| Positions |
2.00 |
2.00 |
|
| • |
|
| |
Replaces general fund captured as part of a prior savings action that assumed a higher federal match for information technology staff working on the Medicaid Enterprise System replacement. Through an Advanced Planning Document approved by CMS, staff costs for certain activities related to the re-procurement, including evaluating proposals, developing requirements, and program management, are eligible for a 90 percent federal match rate. However, this increased match rate will discontinue as the new system enters operational status in FY 2020. After implementation, the match rate will revert to the 50 percent standard Medicaid rate for the hours spent on eligible activities. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$250,000 |
| Nongeneral Fund |
$0 |
($250,000) |
|
| • |
|
| |
Provides funds to cover the increased cost of performing approximately 28,000 TPL verifications annually. In addition, the package provides funding to conduct approximately 2,000 additional verifications per year as well as 675 Medicare verifications. |
| |
| |
FY |
FY |
| General Fund |
$104,175 |
$104,175 |
| Nongeneral Fund |
$104,175 |
$104,175 |
|
| • |
|
| |
Supports a federally required independent evaluation of the GAP waiver. Addiction and Recovery Treatment Services (ARTS) residential and partial hospitalization services were added to the GAP Waiver on October 1, 2017 as directed by the 2017 Appropriations Act. The Centers for Medicare and Medicaid Services are requiring an independent evaluation of the impact of the entire GAP waiver be conducted. |
| |
| |
FY |
FY |
| General Fund |
$85,000 |
$85,000 |
| Nongeneral Fund |
$85,000 |
$85,000 |
|
| • |
|
| |
Provides additional funding to contract with the Virginia Health Care Foundation (VHCF) to increase and retain enrollment in Virginia’s FAMIS programs. The contract will support outreach and enrollment assistance activities that will be conducted by outreach workers and VHCF staff as well as training and technical assistance which includes, but is not limited to, SignUpNow trainings and newsletters and other effective methods, tools, and activities. |
| |
| |
FY |
FY |
| General Fund |
$11,280 |
$19,388 |
| Nongeneral Fund |
$82,720 |
$74,612 |
|
| • |
|
| |
Adds language to specify which hospitals have been awarded the remaining ten graduate medical residency slots from the initial cohort currently funded in the Act. |
| • |
|
| |
Requires the continued collection of local matching dollars associated with payments for Medicaid eligible services provided to children through the Children’s Services Act (CSA). Beginning December 2018, behavioral health services provided to CSA children, including residential services and foster care case management, will be covered under managed care instead of fee-for-service. In the current environment, the Department of Medical Assistance Services (DMAS) sends CSA data on a monthly basis which CSA uses to recover mandated local matching dollars. This language is needed to ensure that DMAS has the ability to continue to send CSA the data necessary to recover local dollars. |
| • |
|
| |
Transfers appropriation between service areas in the agency's administrative program to reflect current operations. Specifically, all appropriation in the Information Technology Services (49902) service area is moved to the General Management and Direction (49901) service area. This action reduces redundancy and eases the management of balances at year end. |
| • |
|
| |
Adds language requiring the agency to provide the Department of Planning and Budget with advance notice of any changes to the state plan or waivers. |
| • |
|
| |
Adds language that requires the Departments of Medical Assistance Services (DMAS) and Social Services to report data that demonstrates the accuracy, efficiency, compliance, quality of customer service, and timeliness of determining eligibility for Medicaid, Children's Health Insurance Program (CHIP) and Governor’s Access Program. Furthermore, DMAS is required to maintain a public dashboard of eligibility performance on its website. |
| • |
|
| |
This amendment provides appropriates revenue generated from the payment rate assessment on private acute care hospitals. |
| |
| |
FY |
FY |
| Nongeneral Fund |
$300,000,000 |
$479,000,000 |
|
| • |
|
| |
This amendment provides $6.6 million the first year and $18.9 million the second year from the general fund and five positions and reduces federal Medicaid matching funds by $24.8 million the first year and $96.1 million the second year, to fund the fiscal impact of the Medicaid Training, Education, Employment and Opportunity Program (TEEOP). The program would take effect upon federal approval of a demonstration waiver to implement Medicaid coverage for individuals with incomes up to 138 percent of the federal poverty level pursuant to the federal Patient Protection and Affordable Care Act. Funding assumes Medicaid expansion pursuant to the Affordable Care Act will begin on January 1, 2019. It is the intent of the General Assembly that in the enrolling of this act, funding included in this item shall be allocated among appropriate items within the Department of Medical Assistance Services and the Department of Social Services. |
| |
| |
FY |
FY |
| General Fund |
$6,560,698 |
$18,900,000 |
| Nongeneral Fund |
($24,849,087) |
($96,123,046) |
| Positions |
8.00 |
8.00 |
|
| • |
|
| |
This amendment eliminates $41.9 million from the general fund and $41.9 million in matching federal Medicaid funds the second year contained in the Medicaid forecast that was included to pay the health insurance fee on managed care contracts as required by the federal Patient Protection and Affordable Care Act. Recent passage of U.S. Public Law No 115-120 suspended this fee for calendar year 2019, which results in a savings in the amount paid by the Department of Medical Assistance Services in fiscal year 2020. |
| |
| |
FY |
FY |
| General Fund |
$0 |
($41,977,057) |
| Nongeneral Fund |
$0 |
($41,977,057) |
|
| • |
|
| |
This amendment restores $39.4 million from the general fund and $40.0 million from federal matching Medicaid funds in the Department of Medical Assistance Services for the Medicaid program. The introduced budget assumed three quarters of savings from the existing Medicaid program that would occur if the program was transformed to cover to newly eligible individuals with incomes up to 138% of the federal poverty level pursuant to the Patient Protection and Affordable Care Act. This amendment assumes that only two quarters of savings from the existing Medicaid program will accrue to the state due to Medicaid transformation beginning on January 1, 2019 instead of October 1, 2018. These savings would accrue since the federal matching rate is higher for individuals in the newly eligible population than in the current Medicaid program (93.5% in fiscal year 2019 compared to 50% for the current Medicaid population). The agency estimates that a number of individuals in the existing Medicaid program will be moved into the newly covered population, along with individuals who obtain health care at the state's teaching hospitals because they are indigent. Companion amendments
in Item 312 and Item 390 restore savings from enhanced Medicaid coverage for individuals served by Community Services Boards and inmate hospitalization payments by the Department of Corrections. |
| |
| |
FY |
FY |
| General Fund |
$39,378,113 |
$0 |
| Nongeneral Fund |
$40,051,676 |
$0 |
|
| • |
|
| |
This amendment provides nongeneral funds from federal Medicaid matching funding and authority for the Department of Medical Assistance Services to adjust Medicaid funding sources for the Commonwealth's two state teaching hospitals, VCU Health System and UVA Medical System and their qualifying partners. In order to maintain federal supplemental funding, language is added to modify the payment methodology to address the move of the state's Medicaid program from fee-for-service to a managed care delivery system. The teaching hospitals will provide the state share of funding to draw down matching federal Medicaid funds, so that no general fund expenditure is needed. |
| |
| |
FY |
FY |
| Nongeneral Fund |
$10,100,000 |
$10,500,000 |
|
| • |
|
| |
This amendment adds funding and language in the second year to provide for a 2.0 percent rate increase for agency and consumer-directed personal and respite care services in the Medicaid program. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$9,850,124 |
| Nongeneral Fund |
$0 |
$9,850,124 |
|
| • |
|
| |
This amendment eliminates funding and language contained in the introduced budget for the proposed 2.0 percent rate increase for consumer-directed personal care, respite, and companion services. A companion amendment reallocates funding in the second year for a 2.0 percent rate increase for both agency directed and consumer directed personal care. |
| |
| |
FY |
FY |
| General Fund |
($4,773,196) |
($5,055,102) |
| Nongeneral Fund |
($4,773,196) |
($5,055,102) |
|
| • |
|
| |
This amendment eliminates the authorization and funding contained in the introduced budget for the Department of Medical Assistance Services to pay overtime compensation to consumer directed attendants in the Medicaid waivers. Agency-directed care is not paid additional funding for overtime costs so this amendment maintains parity and ensures a level playing field in the marketplace. In addition, the U.S. Department of Labor significantly limits the ability to designate individuals as independent contractors, which may lead to the Department of Medical Assistance Services being determined to be the employer of record for consumer directed attendants. If that occurs, paying overtime could result in the Commonwealth being responsible to provide health insurance and workers compensation for these workers. |
| |
| |
FY |
FY |
| General Fund |
$0 |
($9,609,223) |
| Nongeneral Fund |
$0 |
($9,609,223) |
|
| • |
|
| |
This amendment reduces $3.8 million from the general fund and $6.3 million from the nongeneral fund the first year and $1.1 million from the general fund and $3.4 million from the nongeneral fund the second year that was provided in the introduced budget to reprocure the Cover Virginia call center contract. The funding is not needed since the current contract has been extend through June 30, 2020. This amendment eliminates the funding and directs the Secretary of Health and Human Resources to convene an interagency workgroup to assess the programmatic, operational and fiscal impact of consolidating the Cover Virginia call center with the call center operated by the Department of Social Services for its benefit programs, prior to the reprocurement of a contract to operate the Cover Virginia Call Center to determine if efficiencies can be achieved. |
| |
| |
FY |
FY |
| General Fund |
($3,750,000) |
($1,125,000) |
| Nongeneral Fund |
($6,250,000) |
($3,375,000) |
|
| • |
|
| |
This amendment adds 326 Medicaid Family and Individual Support (FIS) Waiver slots in the second year. This is in addition to the slots required by the U.S. Department of Justice Settlement Agreement. A companion amendment provides 1,319 FIS waiver slots in support of the Settlement Agreement. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$5,000,000 |
| Nongeneral Fund |
$0 |
$5,000,000 |
|
| • |
|
| |
This amendment provides $3.0 million the first year and $3.1 million the second year from nongeneral Medicaid funds to increase payments to Chesapeake Regional Medical Hospital, a non-state government owned hospital. Language allows the Department of Medical Assistance Services to make a supplemental payment for allowable costs subject to federal Upper Payment Limits, but requires the hospital to provide the funding to match the federal reimbursement for the supplemental payment. |
| |
| |
FY |
FY |
| Nongeneral Fund |
$3,018,676 |
$3,109,236 |
|
| • |
|
| |
This amendment provides $372,043 from the general fund and $2.4 million in federal funds the first year and $527,793 general fund and $1.4 million from the nongeneral fund the second year to fund costs at the Department of Medical Assistance Services associated with streamlining Medicaid enrollment and application process for Medicaid-eligible adult and juvenile inmates pursuant to House Bill 2183 (2017) study recommendations. These measures are expected to: (i) save state money on managed care contracts by identifying inmates upon incarceration; (ii) automate data exchange between the Department of Medical Assistance Services, the Compensation Board, the Department of Corrections and the Department of Juvenile Justice; (iii) centralize inmate medical applications; and (iv) allow for seamless enrollment upon re-entry. |
| |
| |
FY |
FY |
| General Fund |
$372,043 |
$527,793 |
| Nongeneral Fund |
$2,400,543 |
$1,367,793 |
| Positions |
2.00 |
2.00 |
|
| • |
|
| |
This amendment provides $200,000 from the general fund the first year and $1.5 million from the general fund the second year and a like amount of federal Medicaid matching funds to be used for supplemental payments to fund the second and third years of graduate medical education for 15 funded slots for residents who began their residencies in July 2017, the first and second years of graduate medical education of 14 funded slots for residents beginning their residencies in July 2018, and the first year of graduate medical education of 25 funded slots for residents beginning their residencies in July 2019. This amendment also provides supplemental payments of $50,000 to any residency program at a facility whose Medicaid payments are capped by the Centers for Medicare and Medicaid Services. |
| |
| |
FY |
FY |
| General Fund |
$200,000 |
$1,450,000 |
| Nongeneral Fund |
$200,000 |
$1,450,000 |
|
| • |
|
| |
This amendment restores $453,910 the first year and $635,474 the second year from the general funds and a like amount of federal Medicaid matching funds for Disproportionate Share Hospital (DSH) payments to state behavioral health facilities, Catawba Hospital and Piedmont Geriatric Hospital. The DSH payments were reduced in the introduced budget due to expected federal reductions to state DSH allocations. These DSH reductions were delayed for two years in the Bipartisan Budget Act of 2018. |
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FY |
FY |
| General Fund |
$453,910 |
$635,474 |
| Nongeneral Fund |
$453,910 |
$635,474 |
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This amendment eliminates $500,000 each year from the general fund and $500,000 each year from nongeneral Medicaid funds for the Department of Medical Assistance Services to pay for training of consumer directed attendants. Consumer directed personal attendants are hired by the consumer directly, not the department. The department sets parameters for service providers through policy manuals and regulations. The department does not typically pay providers to attend training on agency policies and regulations. |
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| |
FY |
FY |
| General Fund |
($500,000) |
($500,000) |
| Nongeneral Fund |
($500,000) |
($500,000) |
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This amendment increases the appropriation by $675,000 each year from the fund where civil monetary penalties assessed on nursing facilities are deposited. By federal law and regulation, these funds can only be used to protect the health of nursing facility residents. The Department of Medical Assistance Services is finalizing an application procedure with the federal Centers for Medicare and Medicaid for special projects aimed at improving the quality of care in nursing facilities. However, the current appropriation related to special projects ($325,000 per year) is limited. The additional funds will provide flexibility in project scope or quantity. There are sufficient cash balances to support this added appropriation. |
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| |
FY |
FY |
| Nongeneral Fund |
$675,000 |
$675,000 |
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This amendment adds additional information to be included in the annual November 1 forecast of Medicaid expenditures. The amendment also eliminates an unnecessary quarterly report and replaces it with a report on managed care expenditures in Medicaid to improve reporting on program spending. In addition, an annual report is created to track the costs or savings of changes to services and eligibility made to the Medicaid and FAMIS programs for at least five-years in order to provide better data on how those changes impact expenditure trends over time. |
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This amendment adds language to hold Medicaid Developmentally Disabled (DD) Waiver providers harmless from audit findings under certain circumstances. |
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This amendment adds a sunset provision on language contained in the introduced budget authorizing the Department of Medical Assistance Services to implement supplemental Medicaid payments to teaching hospitals affiliated with an accredited medical school in Planning District 23 (Eastern Virginia Medical School) and Planning District 5 (Virginia Tech Carilion School of Medicine). A companion amendment implements a new statewide hospital provider payment rate assessment on private acute hospitals to increase Medicaid rates for inpatient and outpatient services. The statewide payment rate assessment will be matched with federal Medicaid dollars available for private hospital reimbursements to increase rates, benefiting these two teaching hospitals. However, federal Medicaid matching funds for private acute care hospitals is capped and it is likely that the implementation of statewide rate enhancements will utilize a majority of available federal dollars. Consequently, it is necessary to eliminate authority for separate supplemental payments for these two hospitals would upon the effective date of the statewide hospital provider payment rate assessment on private acute care hospitals. |
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This amendment establishes an annual state spending target for the Medicaid program to increase monitoring, transparency, and accountability over Medicaid spending. The target shall be established by the Joint Subcommittee for Health and Human Resources Oversight and the Governor shall abides by the target in proposing Medicaid spending in the budget. |
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This amendment directs the Department of Medical Assistance Services, in cooperation with the Department of Behavioral Health and Developmental Services, to examine options for increasing participation of community hospitals in providing care to individuals subject to temporary detention orders and to report on these to the Chairmen of the House Appropriations and Senate Finance Committees by September 30, 2018. |
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This amendment directs the Department of Medical Assistance Services to explore private sector technology based platforms and service delivery options to allow qualified, licensed providers to deliver the Consumer-Directed Agency with Choice model in the Commonwealth of Virginia in order to improve quality outcomes, reduce potential for fraud, waste and abuse, and increase efficiency. The department is required to examine the model with stakeholders and to submit a report on its findings to the Chairmen of the House Appropriations and Senate Finance Committees by December 1, 2018. |
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This amendment directs the Department of Medical Assistance Services to improve tracking of pharmacy rebates which will allow better monitoring of overall Medicaid expenditures throughout the year. |
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This amendment modifies budget language included in the introduced budget that directs the Department of Medical Assistance Services to implement electronic visit verification (EVV) as mandated in the federal 21st Century Cures Act. The federal law only required EVV for personal care services whereas the introduced budget also requires it for companion and respite services. EVV is not intended to be used to verify service provided at a location other than the individual's home. This budget language clarifies implementation of EVV does not apply to a provider who does periodic service within their regular program setting (respite provided in a group home, a sponsored residential home, or the Reach Program), as allowed by the Centers for Medicare and Medicaid. Language is added to allow the department to implement the provisions of the EVV prior to the completion of the regulatory process. |
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This amendment implements a recommendation of the Department of Medical Assistance Services' appeals workgroup created in the 2017 Appropriation Act. The amendment allows an extension to the requirement for informal appeals decisions in order to facilitate early settlement discussions between the agency and providers. |
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This amendment adds language to provide authority for the Department of Medical Assistance Services to seek approval from the Centers for Medicare and Medicaid (CMS) to enhance Medicaid coverage to certain low income individuals pursuant to the federal Patient Protection and Affordable Care Act (ACA) within 45 days of the effectiveness of this act. Language requires DMAS to seek federal approval for a State Plan amendment, while simultaneously seeking approval for a Medicaid demonstration waiver to promote efficiency, accountability, personal responsibility, and competitive, value-based purchasing of health care to provide a model of health coverage for participants that is fiscally sustainable and cost effective. Language requires the Department of Medical Assistance Services to transform the Medicaid program for newly eligible individuals pursuant to the federal Patient Protection and Affordability Act (ACA) and the existing Medicaid program.
Language requires that DMAS submit the § 1115 demonstration application to CMS for approval no later than 150 days from the passage of this act. If the State Plan amendments are affirmatively approved by CMS prior to the submission of the waiver, Medicaid coverage for newly eligible individuals may be implemented; however, if the State Plan amendment becomes effective without affirmative action by CMS, coverage may begin upon submission of the completed § 1115 demonstration application, but no later than January 1, 2019. If the demonstration waiver cannot be completed by 150 days, despite a good faith effort to complete the application, the department may request an extension from the Chairmen of the House Appropriations and Senate Finance Committees. Language requires DMAS to provide updates on the progress of the State Plan amendments and waiver applications to the Chairmen of the House Appropriations and Senate Finance Committees upon request and provide for participation in discussions with CMS staff. The department is required to respond to questions from the federal Centers for Medicare and Medicaid on the proposed state plan amendments and demonstration waiver application in a timely manner. Further, the agency is required to notify and submit a copy of the demonstration waiver application at least 10 days prior to federal submission to the Chairmen of the House Appropriations and Senate Finance Committees. If an objection to the demonstration waiver application is made by either Chairman, the department shall make all reasonable attempts to address the objection(s) and modify the waiver. Language requires DMAS to include several provisions through the State Plan amendments, contracts or policy changes such as, referrals to job training, education and job placement assistance for all unemployed, able-bodied adult enrollees. In addition, DMAS is required to include provisions to foster personal responsibility and prepare enrollees for participation in health insurance plans to include use of Medicaid private managed care health plans, premium support for employer-sponsored insurance, health and wellness accounts, appropriate utilization of hospital emergency room services, healthy behavior incentives, and enhanced fraud prevention efforts.
The demonstration waiver requires the development of a premium assistance program for individuals between 100% and 138% of the federal poverty level. It provides for a robust benefit package which includes mental health services and addiction recovery and treatment services. The premium assistance program would include the development of a health and wellness account for eligible individuals comprised of individual contributions and state funding, monthly individual contributions based on a sliding scale not to exceed two percent of monthly income, provisions for the date coverage begins, provisions for a grace period followed by a waiting period prior to re-enrollment if the premium is not paid, and provisions to recover premium payments owed through debt set-off collections. The waiver also requires cost sharing to encourage personal responsibility for individuals with incomes between 100% and 138% of the federal poverty level. However, individuals meeting one of ten exemptions to the Medicaid Training, Education, Employment, and Opportunity Program (TEEOP) would not be subject to cost sharing requirements more stringent than existing Medicaid law or regulations. Enrollees who comply with provisions of the demonstration program, including engaging in healthy behaviors, may receive a decrease in their monthly premiums and copayments, not to exceed 50 percent.
Individuals with incomes between 0 and 100% of the federal poverty level would be enrolled in existing Medicaid private managed care plans with existing Medicaid benefits, subject to existing Medicaid cost sharing requirements.
The language includes requirements that the demonstration waiver engage individuals enrolled in Medicaid in the TEEOP to enable them to increase their health and well-being through community engagement leading to self-sufficiency. Individuals meeting certain exemptions would not be subject to the TEEOP requirements, however, individuals who do not meet the TEEOP requirements three months out of a 12-month period beginning with the first day of enrollment would be disenrolled from the program and will not be permitted to re-enroll until the end of such 12-month period, unless the failure to comply or report compliance was the result of a catastrophic event or circumstances beyond the beneficiary's control. However, the individual may re-enroll in the program upon demonstration of compliance with TEEOP requirements. Language also directs the agency to develop a supportive employment and housing benefit for certain high risk Medicaid beneficiaries who need intensive, ongoing support to obtain and maintain employment and stable housing.
Language is also added to require both the State Plan amendments and demonstration waiver application to include systems for determining eligibility for participation in the program, provisions for disenrollment if federal funding is reduced or terminated and an evaluation component for the project. Finally, language is added to authorize the agency to implement the provisions of the language prior to the completion of the regulatory process. |
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This amendment directs the Department of Medical Assistance Services to utilize Indirect Medical Education (IME) payments in lieu of Disproportionate Share Hospital (DSH) payments for Children's National Medical Center through Medicaid as the hospital is at their federal cap preventing the hospital from being able to accept DSH funding from the Commonwealth. The hospital recently met the state threshold to receive IME payments from the Commonwealth and this language directs the continuation of such payments in lieu of any future DSH payments. |
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This amendment reallocates funding provided for Medicaid Waiver slots for individuals with intellectual and developmental disability to reflect the implementation of the redesigned Waiver programs. The introduced budget provided funding to add 825 Medicaid Waiver slots to meet the funding of former Medicaid Waiver programs and slot requirements contained in the U.S. Department of Justice Settlement Agreement. This amendment provides 384 Community Living Waiver slots, 895 Family and Individuals Support waivers and 40 Building Independent waivers. The reallocation maintains the Commonwealth's funding commitment for the Settlement Agreement, and increases the total number of waiver slots that for each redesigned waiver program that are required to meet the needs and informed choices of the individuals who are expected to fill the slots. Further, waiver slots provided in this budget will allow the Commonwealth to meet the need for any needed transfers between waiver, diversion or transition from institutional care, and emergencies. |
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This amendment creates an annual report the Department of Medical Assistance Services shall submit each year related to supplemental payments to hospitals. |
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This amendment authorizes the Department of Medical Assistance Services to review and adjust private duty nursing services, rates and rate methodologies as a part of Medicaid home and community-based services (HCBS) waivers and the Medicaid Early, Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. The medical necessity criteria for private duty nursing services for individuals in HCBS waivers and those who use the EPSDT benefit has not been evaluated for many years. This review is necessary to ensure that DMAS is applying updated medical necessity criteria that reflects the advances in medical treatment, new technologies, and use of integrated care models that allow medically complex individuals to live longer, healthier lives in their homes and communities. It will also ensure this service is being
utilized in a clinically appropriate and cost effective manner for all Medicaid and FAMIS members and that lower costs services such as skilled nursing, home health nursing, personal care, and behavioral supports are utilized when clinically appropriate. |
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This amendment directs the Department of Medical Assistance Services to review the rates for residential psychiatric treatment facilities, using facility cost reports, to determine whether they are appropriate. A report on findings is due by December 1, 2018. |
