Department of Medical Assistance Services [602]
Secretarial Area: Health and Human Resources
Operating Budget Summary
This table shows the Governor's proposed budget for the next two years and the agency's official budget for the previous six years.
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Biennium Fiscal Year Source GF NGF Total
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 1, 2018 Acts of Assembly $4,450,859,097 $5,472,509,199 $9,923,368,296
2016-2018 2018 Chapter 1, 2018 Acts of Assembly $4,785,782,724 $5,892,680,250 $10,678,462,974
2018-2020 2019 Chapter 1283, 2020 Acts of Assembly $5,008,158,914 $7,594,157,772 $12,602,316,686
2018-2020 2020 Chapter 1283, 2020 Acts of Assembly $4,899,537,379 $10,228,886,509 $15,128,423,888
2020-2022 2021 Chapter 1289, 2020 Acts of Assembly $5,374,833,685 $11,462,754,379 $16,837,588,064
2020-2022 2021 Base Budget $5,159,981,592 $10,545,577,374 $15,705,558,966
2020-2022 2021 Governor's Amendments $163,234,987 $884,968,078 $1,048,203,065
2020-2022 2021 General Assembly Adjustments $51,617,106 $32,208,927 $83,826,033
2020-2022 2022 Chapter 1289, 2020 Acts of Assembly $5,741,826,660 $12,239,269,808 $17,981,096,468
2020-2022 2022 Base Budget $5,159,981,592 $10,545,577,374 $15,705,558,966
2020-2022 2022 Governor's Amendments $525,642,823 $1,653,946,181 $2,179,589,004
2020-2022 2022 General Assembly Adjustments $56,202,245 $39,746,253 $95,948,498
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
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 1, 2018 Acts of Assembly 232.02 241.98 474.00
2016-2018 2018 Chapter 1, 2018 Acts of Assembly 240.02 249.98 490.00
2018-2020 2019 Chapter 1283, 2020 Acts of Assembly 257.52 273.48 531.00
2018-2020 2020 Chapter 1283, 2020 Acts of Assembly 259.52 275.48 535.00
2020-2022 2021 Chapter 1289, 2020 Acts of Assembly 260.02 269.98 530.00
2020-2022 2021 Base Budget 259.52 275.48 535.00
2020-2022 2021 Governor's Amendments 0.50 1.50 2.00
2020-2022 2021 General Assembly Adjustments 0.00 (7.00) (7.00)
2020-2022 2022 Chapter 1289, 2020 Acts of Assembly 260.02 269.98 530.00
2020-2022 2022 Base Budget 259.52 275.48 535.00
2020-2022 2022 Governor's Amendments 0.50 1.50 2.00
2020-2022 2022 General Assembly Adjustments 0.00 (7.00) (7.00)
Operating Budget Addenda (in order of greatest impact)
•
Adjust appropriation for centrally funded 2.75 percent salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the 2.75 percent salary increase for state employees budgeted in Central Appropriations, Item 474 T. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund $1,084,758 $1,084,758
•
Adjust appropriation for centrally funded changes to agency information technology costs Base Budget Adjustment
  Adjusts appropriation for changes to information technology and telecommunications usage budgeted in Central Appropriations, Item 475 G. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund $812,585 $812,585
•
Adjust appropriation for centrally funded 2.25 percent merit-based salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the 2.25 percent merit-based salary increase for state employees budgeted in Central Appropriations, Item 474 V. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund $765,504 $765,504
•
Adjust appropriation for centrally funded changes to state health insurance premiums Base Budget Adjustment
  Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 474 G. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund $374,693 $374,693
•
Adjust appropriation for centrally funded workers’ compensation premium changes Base Budget Adjustment
  Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 474 R. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund ($210,522) ($210,522)
•
Adjust appropriation for centrally funded changes to Performance Budgeting System charges Base Budget Adjustment
  Adjusts appropriation for changes to Performance Budgeting System internal service fund charges budgeted in Central Appropriations, Item 475 M. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund $51,700 $51,700
•
Adjust appropriation for centrally funded state employee other post-employment benefit rate changes Base Budget Adjustment
  Adjusts appropriation for changes to state employee other post-employment benefit rates budgeted in Central Appropriations, Item 474 K. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund ($9,537) ($9,537)
•
Adjust appropriation for centrally funded retirement rate changes Base Budget Adjustment
  Adjusts appropriation for changes to contribution rates for state employee retirement plans budgeted in Central Appropriations, Item 474 H. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund $9,535 $9,535
•
Adjust appropriation for centrally funded changes to Cardinal Financials System charges Base Budget Adjustment
  Adjusts appropriation for changes to Cardinal Financials System internal service fund charges budgeted in Central Appropriations, Item 475 L. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund ($3,765) ($3,765)
•
Adjust appropriation for centrally funded information technology auditors and security officers Base Budget Adjustment
  Adjusts appropriation for information technology auditors and information security officers budgeted in Central Appropriations, Item 475 K. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund ($3,520) ($3,520)
•
Adjust appropriation for centrally funded internal service fund charges for the Personnel Management Information System Base Budget Adjustment
  Adjusts appropriation for Personnel Management Information System internal service fund charges budgeted in Central Appropriations, Item 475 O. of Chapter 854, 2019 Acts of Assembly.
 
  FY FY
General Fund ($3,489) ($3,489)
•
Fund Medicaid utilization and inflation Decision Package
  Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent expenditure forecast.
 
  FY FY
General Fund $174,441,079 $500,534,467
Nongeneral Fund $744,289,657 $1,443,022,309
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Revenue from the Master Settlement Agreement is expected to decline by $10.1 million in FY 2021 and $10.6 million in FY 2022. Tobacco taxes are projected to increase by $117.2 million in 2021 and $124.3 million in 2022 based on the Department of Taxation's revised forecast, which includes revenue from a proposed increase to the cigarette tax. Prior year Medicaid recovery estimates are expected to decrease by $1.5 million in FY 2021 and then grow by $4.1 million in FY 2022. 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 ($105,603,262) ($117,786,979)
Nongeneral Fund $105,603,262 $117,786,979
•
Fund Family Access to Medical Insurance Security (FAMIS) utilization and inflation Decision Package
  Adjusts funding for the FAMIS program to reflect the latest forecast of expenditures. The general fund amount reflects the loss of enhanced federal matching dollars as the match rate for CHIP programs decreased from 76.5 percent to 65 percent in federal FY 2021. In addition to replacing lost federal revenue, FAMIS costs are being driven by continued enrollment growth and higher managed care rates.
 
  FY FY
General Fund $33,985,435 $46,198,275
Nongeneral Fund ($9,424,768) ($6,773,894)
•
Fund medical assistance services for low-income children utilization and inflation Decision Package
  Adjusts funding for the Commonwealth's Medicaid Children's Health Insurance Program to reflect the latest expenditure forecast. Children between the ages of 6 and 19, with family income from 100 to 133 percent of the federal poverty level, are eligible for this program. The general fund amount reflects the loss of enhanced federal matching dollars as the match rate for CHIP programs decreased from 76.5 percent to 65 percent in federal FY 2021. In addition to replacing lost federal revenue, costs are being driven by continued enrollment growth and higher managed care rates.
 
  FY FY
General Fund $27,561,556 $40,780,131
Nongeneral Fund ($13,464,366) ($7,381,536)
•
Increase number of Developmental Disability Waiver slots Decision Package
  Adds a total of 1,135 new waiver slots to the Community Living (CL) and Family and Individual Supports (FIS) waivers over the course of the biennium. These slots include 835 slots to address the FIS waiver waitlist (635 in the first year and 200 in the second year), 200 slots to address the CL waiver waitlist (125 in the first year and 75 in the second year), 50 slots for individuals transitioning out of facilities (25 in each year), and 50 emergency slots (25 in each year).
 
  FY FY
General Fund $16,985,260 $24,828,805
Nongeneral Fund $16,985,260 $24,828,805
•
Encourage private acute care hospitals to accept more temporary detention orders Decision Package
  Increases the provider rate assessment charged to private acute care hospitals by $16.3 million beginning in FY 2021. This additional revenue will be used to provide incentive DSH payments to support increased temporary detention order (TDO) utilization in private acute care hospitals. In addition, the Departments of Medical Assistance Services and Behavioral Health and Developmental Services are each provided funding to support a position that will administer this initiative.
 
  FY FY
Nongeneral Fund $32,523,924 $32,523,924
Positions 1.00 1.00
•
Fund home visiting services Decision Package
  Implements a home visiting benefit for pregnant and post-partum women at risk of poor health outcomes effective July 1, 2021. Prior to implementation, DMAS shall engage all relevant stakeholders in the development of the benefit and gaining the necessary federal approvals.
 
  FY FY
General Fund $1,054,300 $11,750,159
Nongeneral Fund $3,514,556 $34,216,923
•
Redesign COMPASS 1115 waiver Decision Package
  Adjusts appropriation and language to restructure the COMPASS 1115 waiver to include only a targeted supportive employment and housing benefit.
 
  FY FY
Nongeneral Fund ($17,265,286) ($17,265,286)
•
Adjust training center budgets to reflect anticipated costs 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 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 ($4,761,147) ($13,898,647)
Nongeneral Fund ($2,996,518) ($12,134,018)
•
Enhance behavioral health services Decision Package
  Provides funding and authority to establish and implement changes to service definitions, prior authorization and utilization review criteria, provider qualifications, and reimbursement rates for select Medicaid behavioral health services.
 
  FY FY
General Fund $3,028,038 $10,273,553
Nongeneral Fund $4,127,378 $14,070,322
•
Provide care coordination prior to release from incarceration Decision Package
  Provides funding and authority to offer care coordination services to individuals who are Medicaid eligible 30 days prior to release from incarceration.
 
  FY FY
General Fund $347,803 $465,440
Nongeneral Fund $11,398,558 $16,404,809
•
Adjust appropriation to reflect agency operations Decision Package
  Moves appropriation and positions between service areas and fund details to ensure that all agency services are properly budgeted. This includes the transfer of $3.0 million general fund in FY 2021 and $3.6 million general fund in FY 2022 within administrative service areas to account for the reduction of federal match for CHIP programs. In addition, nongeneral fund appropriation is being removed, from the federal Medicaid Incentive Program and Vision to Learn, to account for anticipated operations.
 
  FY FY
Nongeneral Fund ($9,070,265) ($12,580,265)
•
Eliminate 40 quarter work requirement for legal permanent residents Decision Package
  Eliminates the 40-quarter work requirement for lawful permanent residents (LPRs). The current requirement prevents otherwise eligible individuals from receiving needed care and increases unnecessary and expensive emergency care.
 
  FY FY
General Fund $1,172,091 $3,289,890
Nongeneral Fund $6,519,419 $9,548,955
•
Increase Developmental Disability (DD) waiver rates Decision Package
  Increases provider payment rates for services delivered through the Developmental Disability (DD) waivers. The rate increase will apply to the following services: Independent Living Supports Supported Living, In-home Support Services, Group Supported Employment, Workplace Assistance, Community Engagement, Community Coaching, and Therapeutic Consultation.
 
  FY FY
General Fund $3,639,663 $3,748,853
Nongeneral Fund $3,639,663 $3,748,853
•
Increase mental health provider rates Decision Package
  Raises rates for psychiatric services by 14.7 percent. This action increases rates to the equivalent of 110 percent of the 2019 Medicare rates for these services.
 
  FY FY
General Fund $2,374,698 $2,458,479
Nongeneral Fund $4,370,186 $4,488,751
•
Fund Managed Care Contract Changes Decision Package
  Provides funding and authority to include a number of changes to the 2020-2021 managed care contracts.
 
  FY FY
General Fund $2,226,600 $2,428,350
Nongeneral Fund $2,226,600 $2,428,350
•
Extend FAMIS MOMS' postpartum coverage to 12 months Decision Package
  Extends postpartum coverage for FAMIS MOMS from 60 days to 12 months. Currently, women up to 205 percent of the federal poverty level are eligible for coverage during their pregnancy and up to 60 days postpartum from the delivery date on file.
 
  FY FY
General Fund $1,114,936 $2,116,376
Nongeneral Fund $2,120,272 $3,930,412
•
Restore funding for obesity and tobacco prevention Decision Package
  Removes language that sets the percentage of Master Settlement Agreement (MSA) revenue deposited into the VIrginia Health Care Fund at 41.5 percent. As such, MSA deposits to the VHCF will revert to 40 percent as directed in the Code of Virginia. In addition, language redirecting MSA Strategic Contribution Payments is also removed. This action restores approximately $1.7 million annually to the Virginia Foundation for Healthy Youth and requires that $1.7 million general fund be restored to the VHCF to replace the revenue that would have been used as Medicaid matching dollars.
 
  FY FY
General Fund $1,734,940 $1,716,867
Nongeneral Fund ($1,734,940) ($1,716,867)
•
Fund costs of Medicaid-reimbursable STEP-VA services Decision Package
  Provides funds for the Medicaid costs associated with the implementation of STEP-VA behavioral health services.
 
  FY FY
General Fund $486,951 $2,293,826
Nongeneral Fund $486,951 $2,293,826
•
Expand opioid treatment services Decision Package
  Provides funding to expand the Preferred Office-Based Opioid Treatment (OBOT) model to allow for all Substance Use Disorders (SUD) covered in the Addiction and Recovery Treatment Services (ARTS) benefit. The Preferred OBOT is a community-based, high-touch, evidence-based model of care for individuals with addiction. Virginia Medicaid currently limits service reimbursement in the Preferred OBOT to individuals with Opioid Use Disorder (OUD). Those with a primary diagnosis of SUD for a non-opioid such as alcohol, cocaine, or methamphetamine are not currently covered in the Preferred OBOT model.
 
  FY FY
General Fund $421,476 $1,273,633
Nongeneral Fund $620,156 $1,873,300
•
Allow FAMIS MOMS to access substance use disorder treatment in an institution for mental disease Decision Package
  Provides funding to allow FAMIS MOMS to access medically necessary treatment for a substance use disorder in an Institution for Mental Diseases (IMD) under the Addiction and Recovery Treatment Services (ARTS) waiver.
 
  FY FY
General Fund $307,500 $356,775
Nongeneral Fund $626,900 $662,550
•
Reduce contract spending Decision Package
  Accounts for lower spending on support contracts as the agency shifts to lower cost alternatives.
 
  FY FY
General Fund ($302,787) ($302,787)
Nongeneral Fund ($302,787) ($302,787)
•
Implement episodic payment models for certain conditions Decision Package
  Requires the development and implementation of episode-based payment models for maternity care, asthma, and congestive heart failure. The department shall develop these models with a goal of reducing costs and improving the quality of care for Medicaid members.
 
  FY FY
General Fund $151,915 $249,415
Nongeneral Fund $174,266 $271,766
Positions 1.00 1.00
•
Adjust Medicaid forecasting process Decision Package
  Updates the Medicaid forecasting process and deliverables to improve transparency and enhance external oversight.
•
Clarify provider assessment language Decision Package
  Updates language for both the coverage and rate provider assessments. These changes conform the Act language to current practice and make technical adjustments to improve the efficiency of both programs. None of the changes will have any impact on the overall amount of revenue collected or how funds are expended.
•
Offset lost federal revenue for Children's Hospital of The King's Daughters (CHKD) Decision Package
  Authorizes the department to create additional hospital supplemental payments for CHKD to replace payments that have been reduced due to the federal regulation on the definition of uncompensated care costs effective June 2, 2017. These new payments will equal what would have been paid to CHKD under the current disproportionate share hospital (DSH) formula.
•
Increase Rates for Personal, Respite and Companion Care General Assembly Adjustment
  This amendment provides $24.9 million the first year and $39.9 million the second year from the general fund and a like amount of federal Medicaid matching funds each year to increase provider rates for personal care, respite care, and companionship services provided in Medicaid waiver programs by five percent the first year and two percent the second year. These rate increases will help to address the impact of a change in the state minimum wage related to the labor costs for providing these services.
 
  FY FY
General Fund $24,917,194 $39,857,314
Nongeneral Fund $24,917,194 $39,857,314
•
Add Medicaid Adult Dental Benefit General Assembly Adjustment
  This amendment provides $8.7 million from the general fund and $23.4 million in nongeneral funds the first year and $25.3 million from the general fund and $67.7 million in nongeneral funds the second year to provide a comprehensive dental benefit, beginning on January 1, 2021, to adults enrolled in the Virginia Medicaid program. The adult dental benefit will not include any cosmetic, aesthetic or orthodontic services.
 
  FY FY
General Fund $8,743,420 $25,304,935
Nongeneral Fund $23,401,506 $67,727,915
•
Capture ACA Insurance Tax Savings General Assembly Adjustment
  This amendment reduces $30.6 million from the general fund and $61.2 million in matching federal Medicaid funds the second year to reflect the impact of the elimination of the tax on health insurers beginning calendar year 2021. The recent budget passed by Congress eliminates the tax. The tax on health insurers was created in the Affordable Care Act and is imposed on Medicaid managed care companies, which is the reason the tax impacts the state budget.
 
  FY FY
General Fund $0 ($30,565,273)
Nongeneral Fund $0 ($61,238,889)
•
Increase DD Waiver Provider Rates Using Updated Data General Assembly Adjustment
  This amendment provides $21.4 million the first year and $22.0 million the second year from the general fund and matching federal Medicaid funds each year to increase provider rates for services provided through the current Medicaid Developmental Disability Waiver programs using updated data measures available, including wage assumptions, to 100 percent of the rate model benchmark. These increases will assist providers to recruit and retain qualified staff to meet standards mandated by the requirements of the U.S. Department of Justice Settlement Agreement.
 
  FY FY
General Fund $21,395,221 $22,037,077
Nongeneral Fund $21,395,221 $22,037,077
•
Implement Emergency Room Utilization Program General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to allow the pending, reviewing and reducing of fees for avoidable emergency room level two, three and four claims, both physician and facility. The department would utilize the avoidable emergency room diagnosis code list currently used for Managed Care Organization clinical efficiency rate adjustments. If the emergency room claim is identified as a preventable emergency room diagnosis, the department shall direct the Managed Care Organizations to default to a payment level one. The amendment captures savings to the Medicaid program from the implementation of this policy.
 
  FY FY
General Fund ($14,142,590) ($14,459,101)
Nongeneral Fund ($26,299,006) ($26,791,327)
•
Eliminate TDO DSH Incentive Program General Assembly Adjustment
  This amendment eliminates the proposed supplemental payment program to incentivize private hospitals to increase their Temporary Detention Order admissions. The methodology to implement such a program may not have the intended effect and also requires the hospitals to use their funding for the state share. A companion amendment in the Department of Behavioral Health and Developmental Services funds pilot projects to more quickly divert TDO admissions and relieve the census pressure on state hospitals.
 
  FY FY
Nongeneral Fund ($32,413,924) ($32,413,924)
•
Allow Overtime for Personal Care Attendants General Assembly Adjustment
  This amendment provides $9.6 million from the general fund and a like amount of federal Medicaid matching funds each year for the Department of Medical Assistance Services, beginning July 1, 2020, to pay overtime compensation to personal care attendants who are providing care under the consumer-directed service option in Medicaid waivers. The amendment allows Medicaid 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 $9,609,223 $9,609,223
Nongeneral Fund $9,609,223 $9,609,223
•
Account for Lower Managed Care Rates for CCC Plus General Assembly Adjustment
  This amendment accounts for the Department of Medical Assistance Services adopting lower managed care rates for the Commonwealth Coordinated Care Plus program (effective January 1, 2020) than those assumed in the November 1, 2019 official Medicaid forecast.
 
  FY FY
General Fund ($8,726,537) ($9,373,101)
Nongeneral Fund ($8,726,537) ($9,373,101)
•
Increase Residential Psychiatric Facility Rates General Assembly Adjustment
  This amendment provides $7.6 million from the general fund each year and a like amount of federal Medicaid matching funds to increase reimbursement to residential psychiatric facilities. The rates paid to these facilities, not unlike other institutional providers (hospitals, nursing facilities, etc.), have not increased since 2008 and have not been adjusted for inflation. These facilities serve only children in a clinically and medically-necessary active treatment program designed to provide necessary support and address mental health, behavioral, substance abuse, cognitive and training needs in order to prevent or minimize the need for more intensive outpatient treatment, per federal regulations. This amendment also strikes language that prohibits annual inflation adjustments.
 
  FY FY
General Fund $7,599,696 $7,599,696
Nongeneral Fund $7,599,696 $7,599,696
•
Implement Medicaid Hospital Readmissions Policy General Assembly Adjustment
  This amendment adds language to modify the definition of hospital readmissions to change it to 30 days making the readmission criteria for both Medicaid managed care organizations (MCOs) and providers more aligned with Medicare policy. Hospital readmissions after five days but within 30 days shall be paid at 50 percent of the normal rate.
 
  FY FY
General Fund ($5,680,341) ($5,792,214)
Nongeneral Fund ($9,106,611) ($9,275,260)
•
Modify Medicaid Nursing Facility Reimbursement General Assembly Adjustment
  This amendment provides $6.8 million the first year and $7.0 million the second year from the general fund and a like amount of matching federal Medicaid funding each year to increase the peer group adjustment factors used in nursing facility reimbursement in order to account for lower cost facilities inappropriately suppressing Medicaid rates for facilities with higher costs. The second year amount assumes inflation at 2.7 percent.
 
  FY FY
General Fund $6,794,541 $6,984,788
Nongeneral Fund $6,794,540 $6,984,787
•
Increase Rates for Skilled and Private Duty Nursing Services General Assembly Adjustment
  This amendment increases the Medicaid rates for skilled and private duty nursing services to 80 percent of the benchmark rate effective July 1, 2020. This shall apply to skilled nursing services provided through the Developmental Disability Waiver programs and private duty nursing services including congregate nursing services provided in the Commonwealth Coordinated Care Plus Waiver, the Developmental Disability Waiver programs and the Early and Periodic Screening, Diagnostic and Treatment program. This amendment increases the skilled nursing rates by 16.1 percent and private duty nursing rates by an average of 11.6 percent.
 
  FY FY
General Fund $6,245,286 $6,245,286
Nongeneral Fund $6,245,286 $6,245,286
•
Provide Chesapeake Regional Hospital Medicaid DSH Supplement General Assembly Adjustment
  This amendment adds $12.0 million each year from federal Medicaid funds and language directing the Department of Medical Assistance Services to implement a supplemental disproportionate share hospital (DSH) payment for Chesapeake Regional Hospital. The hospital would be responsible for transferring the non-federal share of the funding to the agency in order to draw down the matching federal Medicaid funds.
 
  FY FY
Nongeneral Fund $12,000,000 $12,000,000
•
Account for Medicaid MCO Contracts with Pharmacy Benefits Managers General Assembly Adjustment
  This amendment captures savings to the state's Medicaid program from the passage of House Bill 1291 and Senate Bill 568, which prohibit Medicaid managed care organizations (MCOs) from engaging in the conduct of 'spread pricing' with the MCOs' contracted pharmacy benefits manager. This prohibition saves $4.1 million from the general fund and $6.8 million from nongeneral funds the first year and $4.3 million from the general fund and $7.1 million from nongeneral funds the second year in the state's Medicaid program.
 
  FY FY
General Fund ($4,115,274) ($4,289,871)
Nongeneral Fund ($6,805,641) ($7,067,880)
•
Adjust the Health Care Fund for Updated Revenue Estimates General Assembly Adjustment
  This amendment adjusts the Virginia Health Care Fund appropriation to reflect updated estimates of tobacco and nicotine vapor product revenue based on proposed tax increases. Since the Health Care Fund is used as state match for Medicaid, any increase in revenue offsets general fund support for Medicaid costs.
 
  FY FY
General Fund ($3,180,000) ($5,130,000)
Nongeneral Fund $3,180,000 $5,130,000
•
Reduce Administrative Funding and Positions for COMPASS Waiver General Assembly Adjustment
  This amendment reduces the nongeneral fund appropriation and six positions remaining in the Department of Medical Assistance Services' budget for implementing the requirements of the COMPASS waiver. The introduced budget eliminated many of the waiver's requirements and as such the remaining administrative funding is adjusted to reflect the remaining scope of the waiver. The amendment leaves two positions, at a cost of $257,643 each year and $1.5 million each year for vendor costs related to continuing development and implementation of the remaining portions of the waiver. Half of the funding is to provide the hospital provider assessment for the state match and the other half is from federal Medicaid funds.
 
  FY FY
Nongeneral Fund ($5,457,643) ($5,457,643)
Positions (6.00) (6.00)
•
Add 250 Family and Individual Support (FIS) Waiver Slots in FY 2022 General Assembly Adjustment
  This amendment provides $4.1 million from the general fund the second year and a like amount of matching federal Medicaid funds to increase the number of Family and Individual Support (FIS) waiver slots by 250 in the second year bringing the total number of FIS slots funded to 465.
 
  FY FY
General Fund $0 $4,133,500
Nongeneral Fund $0 $4,133,500
•
Increase Funding for Medicaid Graduate Medical Education Residency Slots General Assembly Adjustment
  This amendment provides $1.3 million the first year and $2.5 million the second year from the general fund to correct an oversight in the Official Medicaid Forecast that removed funding for new residency slots for this program. Included in this funding is $100,000 from the general fund and $100,000 from nongeneral funds for the Graduate Medical Education residency program each year of the biennium, to provide funding for 27 slots, rather than 25, for the residents who start in July 2021.
 
  FY FY
General Fund $1,350,000 $2,600,000
Nongeneral Fund $1,350,000 $2,600,000
•
Restore MSA Payment Distribution to Medicaid General Assembly Adjustment
  This amendment reduces the general fund by $1.7 million each year along with a corresponding increase in the Health Care Fund appropriation to restore the allocation of the Master Settlement Agreement with tobacco manufacturers revenue to 41.5 percent. The introduced budget reduced this allocation to 40 percent, resulting in the need for additional general fund amounts to offset the Health Care Fund revenue that is used as state match for the Medicaid program.
 
  FY FY
General Fund ($1,734,940) ($1,716,867)
Nongeneral Fund $1,734,940 $1,716,867
•
Modify Managed Care Contract Changes General Assembly Adjustment
  This amendment reduces $1.4 million from the general fund and a like amount of federal Medicaid funds related to eliminating a proposed contract change with Medicaid managed care organizations that would have allowed them to pay $100 to plan members rather than the current $50 for giveaways or incentives. In addition, language is added directing the CCC Plus plans to upgrade Medicare Dual Special Needs Plans (D-SNPs) to Medicare Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPS).
 
  FY FY
General Fund ($1,414,000) ($1,414,000)
Nongeneral Fund ($1,414,000) ($1,414,000)
•
Remove First Year Funds for New Home Visiting Benefit General Assembly Adjustment
  This amendment eliminates $1.1 million general fund and $3.5 million in federal Medicaid funds the first year provided for a new home visiting benefit in Medicaid. The new benefit does not begin until the second year, so the first year funding is unnecessary.
 
  FY FY
General Fund ($1,054,300) $0
Nongeneral Fund ($3,514,556) $0
•
Fund initial cost of COVID-19 response (Reconvened Amendment) General Assembly Adjustment
  Increases funding to cover the cost of policy changes implemented by the Department of Medical Assistance Services in response to COVID-19. These actions include expanding the use of telemedicine, waiving service authorizations and eliminating cost sharing.
 
  FY FY
General Fund $1,032,955 $0
Nongeneral Fund $2,661,925 $0
•
Increase Rate for Adult Day Health Care General Assembly Adjustment
  This amendment adds $796,755 the first year and $833,109 the second year from the general fund and a like amount of matching federal Medicaid funds each year to increase adult day health care rates by 10 percent, effective July 1, 2020.
 
  FY FY
General Fund $796,755 $833,109
Nongeneral Fund $796,755 $833,109
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Modify Nursing Facility Operating Rates at Four Facilities General Assembly Adjustment
  This amendment adds $733,303 the first year and $754,247 the second year from the general fund and a like amount of matching federal Medicaid funds each year to require the Department of Medical Assistance Services to adjust the nursing facility operating rates for any nursing facility that changed ownership under certain parameters. This language would affect four facilities located in Harrisonburg, Lynchburg, Roanoke and Waynesboro.
 
  FY FY
General Fund $733,303 $754,247
Nongeneral Fund $733,303 $754,247
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Begin Supporting Poison Control Centers in FY 2022 General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to fund $2.5 million the second year for three Poison Control centers serving Virginia as part of a Health Services Initiative, which allows the state to use federal Children's Health Insurance Program administrative funding for such activities. Funding from the general fund of $875,000 is provided for the 35 percent state share. A companion amendment in Item 303 eliminates the second year appropriation of $1.0 million from the general fund in the budget for the Virginia Department of Health related to Poison Control centers. Upon enrolling of the bill, the funding in this amendment will be set out in a separate service area in the Administrative and Support Services program (49900).
 
  FY FY
General Fund $0 $875,000
Nongeneral Fund $0 $1,625,000
•
Increase Medicaid Rates for Anesthesiologists General Assembly Adjustment
  This amendment provides $253,376 from the general fund and $791,234 in nongeneral funds the first year and $262,491 from the general fund and $813,458 in nongeneral funds the second year to increase Medicaid reimbursement for anesthesiologists to 70 percent of the equivalent Medicare rate in the fee for service and managed care programs. The intent of the 2019 General Assembly was to increase Medicaid reimbursement to 70 percent of the equivalent Medicare fee to physicians who were reimbursed less than 70 percent of Medicare rates.The anesthesiologists qualified for this increase but were inadvertently left out of the budget language. This amendment will correct that and bring them up to 70 percent of the Medicare rate.
 
  FY FY
General Fund $253,376 $262,491
Nongeneral Fund $791,234 $813,458
•
Cover Administrative Cost of Implementing Live-In Caretaker Exemption General Assembly Adjustment
  This amendment provides $507,500 the first year and $373,000 the second year from the general fund and $776,500 the first year and $373,000 the second year from nongeneral funds to fund the administrative costs related to exempting live-in caretakers from the electronic visit verification requirement. This funding will cover increased costs for the fiscal / employer agent and managed care organizations.
 
  FY FY
General Fund $507,500 $373,000
Nongeneral Fund $776,500 $373,000
•
Increase Payment Rate for Nursing Homes with Special Populations General Assembly Adjustment
  This amendment adds funding each year and language 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 2021. 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 $493,097 $506,903
Nongeneral Fund $493,097 $506,903
•
Increase Appropriation for Civil Money Penalties General Assembly Adjustment
  This amendment provides authority for the agency to spend additional revenue from civil money penalties in order to be in compliance with federal rules.
 
  FY FY
Nongeneral Fund $320,000 $1,310,000
•
Require Minimum Medicaid MCO Reimbursement for Durable Medical Equipment General Assembly Adjustment
  This amendment adds funding and language requiring Medicaid managed care organizations to reimburse at no less than 90 percent of the state Medicaid fee schedule for reimbursing durable medical equipment.
 
  FY FY
General Fund $345,621 $352,534
Nongeneral Fund $431,056 $439,677
•
Increase Supplemental Payments for Children's National Medical Center General Assembly Adjustment
  This amendment provides $354,766 from the general fund each year and matching federal Medicaid funds to increase supplemental physician payments for physicians employed at Children's National, a freestanding children's hospital serving the Northern Virginia region.
 
  FY FY
General Fund $354,766 $354,766
Nongeneral Fund $354,766 $354,766
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Expand Medicaid Works for Individuals with Disabilities General Assembly Adjustment
  This amendment adds $114,419 the first year and $228,838 the second year from the general fund and a like amount of matching federal Medicaid funds to increase the eligibility requirement for Virginians with disabilities to participate in the Medicaid Works program to 138 percent of the federal poverty level (FPL). The current program eligibility remains at 80 percent of FPL ($833/month) and was not adjusted when the eligibility for Medicaid was increased with Medicaid Expansion ($1,436/month). The current eligibility rules at 80 percent of FPL discourages individuals with disabilities from moving into employment for fear of losing their Medicaid coverage. As a result, only 52 individuals with disabilities currently participate in the program.
 
  FY FY
General Fund $114,419 $228,838
Nongeneral Fund $114,419 $228,838
•
Fund an Anaysis of Medicaid Rates General Assembly Adjustment
  This amendment provides $300,000 the first year from the general fund and $300,000 from nongeneral funds for the Department of Medical Assistance Services to contract with a consultant with expertise in health care rate setting to thoroughly analyze current Medicaid rates for services likely impacted by an increase in the state minimum wage.
 
  FY FY
General Fund $300,000 $0
Nongeneral Fund $300,000 $0
•
Modify Capital Reimbursement for Certain Nursing Facilities General Assembly Adjustment
  This amendment adds $119,995 from the general fund each year and a like amount of matching federal Medicaid funds and language to require the Department of Medical Assistance Services to modify nursing facility capital reimbursement for a nursing facility that lost its status as a hospital-based nursing facility because a replacement hospital was built in a different location and it becomes a free-standing facility.
 
  FY FY
General Fund $119,955 $119,955
Nongeneral Fund $119,955 $119,955
•
Reduce Administrative Funding for Episodic Payment Models General Assembly Adjustment
  This amendment reduces administrative funding provided in the introduced budget related to expanding the use of episodic payment models in Medicaid. The amendment leaves the Department of Medical Assistance Services with one position for the Office of Value Based Purchasing and $44,702 the first year and $138,973 the second year in total funds for contractor costs to assist in developing and implementing episodic payment models.
 
  FY FY
General Fund ($75,958) ($124,708)
Nongeneral Fund ($98,489) ($147,059)
•
Eliminate Position for TDO DSH Incentive Program General Assembly Adjustment
  This amendment eliminates the position related to the proposed supplemental payment program to incentivize private hospitals to increase their Temporary Detention Order admissions.
 
  FY FY
Nongeneral Fund ($110,000) ($110,000)
Positions (1.00) (1.00)
•
Expand Tobacco Cessation Coverage General Assembly Adjustment
  This amendment provides $34,718 from the general fund each year and a like amount of federal Medicaid matching funds to add tobacco cessation services to the Medicaid program for adults otherwise not covered currently. The federal Patient Protection and Affordable Care Act (ACA) requires that Medicaid provide coverage for prevention services, including tobacco cessation, for individuals enrolled pursuant to the ACA. This amendment allows all adults in Medicaid to have access to tobacco cessation services.
 
  FY FY
General Fund $34,718 $34,718
Nongeneral Fund $34,718 $34,718
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Add Community Behavioral Health Managed Care Requirements General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to amend its contracts with managed care organization to ensure service authorizations for community mental health and rehabilitation services are handled in a timely and transparent manner.
•
Add Medicaid Call Center Requirements General Assembly Adjustment
  This amendment directs the Departments of Medical Assistance Services and Social Services to establish, by no later than July 1, 2021, a single phone number for the Cover Virginia call center and the call center operated by Department of Social Services such that the call is routed to the appropriate call center.
•
Add Representative to Pharmacy Liaison Committee General Assembly Adjustment
  This amendment adds a representative from federally qualified health centers to the Pharmacy Liaison Committee in the Department of Medical Assistance Services.
•
Adjust Medicaid Special Earnings Allowance for Individuals with Disabilities General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to make changes to the post eligibility special earnings allowance for individuals in Medicaid waiver programs to incentivize employment.
•
Allow For Nursing Home Specialized Care Rates General Assembly Adjustment
  This amendment adds language authorizing the Department of Medical Assistance Services (DMAS) to use an alternate methodology for setting operating rates for nursing homes that provide specialized care (ventilator care, tracheotomy care, etc.) over the 2020-22 biennium until the agency has more reliable managed care cost data. Unlike nursing facility rates that are rebased every three years, and this is a completely separate rate development from the usual nursing facility rates. Because the most recent cost reports to be used for these rates have data integrity problems, this alternative methodology will allow the agency time to ensure the data is accurate and reliable in setting the rates beyond fiscal year 2022.
•
Analyze Health Benefit Exchange and Medicaid Costs General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to conduct a fiscal analysis of the provisions of House Bill 1428 / Senate Bill 732 that creates the Virginia Health Benefits Exchange and leverages state income tax returns to facilitate the enrollment of eligible individuals in insurance affordability programs.
•
Authorize changes to medical assistance programs in response to COVID-19 (Reconvened Amendment) General Assembly Adjustment
  Provides DMAS temporary authority to make immediate changes to its medical assistance programs in response to COVID-19. Any change would be subject to the Governor’s approval and must be reported within 15 days. Authorization and any program changes will expire with the Governor’s emergency declaration.
•
Convene Advisory Group on Respite/Personal Assistance Services General Assembly Adjustment
  This amendment adds language requiring DMAS to convene a workgroup of stakeholders to review existing and any proposed regulations on the provision of respite or personal assistance services to determine the barriers to the provision of these services in certain settings. Language requires DMAS to report on the conclusions of the workgroup, including the need for emergency regulatory authority to minimize any barriers to services and support broader appropriate utilization of such services.
•
Convene DMAS Advisory Panel on Behavioral Health Redesign General Assembly Adjustment
  This amendment adds language requiring DMAS to convene an advisory panel of representatives from stakeholder organizations to review and advise on agency efforts to redesign behavioral health services, including specifics of implementation and a review of operational processes that affect sustainable business models. Language requires DMAS to report on its findings from this review by December 31, 2020.
•
Develop Medicaid Referral Program for Employment Services General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to develop a referral system designed to connect current and newly eligible Medicaid enrollees to employment, training, and education assistance and other support services.
•
Develop Plan to Pursue Mental Health Services Waiver General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to continue working with the Department of Behavioral Health and Developmental Services to complete the actions necessary to qualify to file an 1115 waiver application for Serious Mental Illness and/or Serious Emotional Disturbance. The department shall then develop such a waiver application that shall be consistent with the Addiction and Recovery Treatment Services waiver program.
•
Establish Workgroup on Medicaid Payment Policies and Care Coordination General Assembly Adjustment
  This amendment establishes a stakeholder workgroup lead by the Department of Medical Assistance Services to develop strategies and recommendations to reduce hospital readmissions, improve emergency department utilization and enhance value-based payment in the Medicaid program.
•
Evaluate Sick Leave Program for Personal Care Attendants General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to conduct a review of other state methods and strategies to provide sick leave to personal care attendants and evaluate feasible options for the Commonwealth to consider. The department will report its findings and recommendations to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees by November 1, 2020.
•
Examine Medicaid Coverage of Innovative Drugs and Emerging Technologies General Assembly Adjustment
  This amendment adds language requiring the Department of Medical Assistance Services to establish a workgroup to assess and determine a process for Medicaid coverage and reimbursement of emerging technologies and innovative drugs that are approved by the Food and Drug Administration. Language requires the workgroup to report on issues and recommendations to the Joint Subcommittee for Health and Human Resources Oversight by September 1, 2020.
•
Examine Opportunities to Make Additional Medicaid Payments for EVMS General Assembly Adjustment
  This amendment adds language to require the Department of Medical Assistance Services to determine if any additional Medicaid payment opportunities could be made to a teaching hospital affiliated with an accredited medical school in Planning District 23 based on the department's reimbursement methodology established for such payments and to determine the framework for implementing such payments. Language requires a reasonable cap on such payments if determined available, so as not to adversely impact other qualifying entities in future years.
•
Exempt Live-in Caretakers from EVV Program General Assembly Adjustment
  This amendment exempts live-in personal care providers from requirements to participate in the Electronic Visit Verification system beginning January 1, 2021. The Centers for Medicare and Medicaid Services have made this exemption an option for states to choose to implement.
•
Implement a Medicaid Risk Adjustment Model General Assembly Adjustment
  This amendment adds language requiring the Department of Medical Assistance Services to develop and implement by January 1, 2021, a risk adjustment model which addresses behavioral health acuity differences among the Medicaid managed care organizations for the community well population of individuals who are dually eligible for Medicare and Medicaid programs and served through the CCC Plus managed care program. Language also requires the department to develop different capitation rates for the remaining population served under the CCC Plus program and who are receiving behavioral health treatment for potential implementation. The net impact of these change must be budget neutral.
•
Increase nursing facility rates in response to COVID-19 (Reconvened Amendment) General Assembly Adjustment
  Adds language that directs DMAS to increase nursing home and specialized care per diem rates by $20 per day per patient effective for the period of the Governor's Declaration of a State of Emergency due to COVID-19. Further, authorization for a treasury loan is provided should appropriated state funding be insufficient to cover costs.
•
Investigate Potential Medicaid Reimbursements for School-Based Services General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to consider options to allow local education agencies to bill for services provided outside of an Individualized Education Plan and expand the services that are reimbursable.
•
Modify Medallion and CCC Plus Contracts General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to conduct an analysis merging the profit cap and revenue sharing in the Medicaid managed care programs. Currently the Department of Medical Assistance Services contracts with the same six managed care organizations for its two managed care programs, CCC Plus and Medallion 4.0, with separate medical loss ratios and underwriting gain provisions. In addition, language directs the department to submit a plan and feasible timeline for merging the Commonwealth Coordinated Care Plus and Medallion 4.0 programs.
•
Modify Quarterly Medicaid Financial Review Committee General Assembly Adjustment
  This amendment modifies the quarterly meeting on Medicaid expenditures to clarify the main purpose of each meeting and to specify when the meeting will be held. This amendment also removes the specific reporting requirement on the Discrete Incentive Transition Program.
•
Modify Reporting Requirement on Medicaid Waivers and State Plan Changes General Assembly Adjustment
  This amendment clarifies that the reporting process for review of state plan amendments or waivers be submitted to the Department of Planning and Budget (DPB) for review 45 days prior to submission to the Centers for Medicare and Medicaid Services to allow DPB adequate time for such review. The language clarifies that renewals of waivers are also to be included in any such review. In addition, the language requires reporting to the money committees.
•
Provide flexibility to adjust medical assistance payment dates (Reconvened Amendment) General Assembly Adjustment
  Allows DMAS to advance any appropriate and allowable payment in an effort to take advantage of enhanced federal matching funds.
•
Remove Outdated Language General Assembly Adjustment
  This amendment eliminates three paragraphs in the introduced budget that have been included for several years and are no longer necessary. The first paragraph directs expansion of all Medicaid services and populations into managed care, which has occurred for the most part. The remaining services and populations should only be moved into managed care if explicitly authorized by the General Assembly. The second paragraph eliminates a notification process related to submitting the § 1115 waiver related to the expansion pursuant to the Affordable Care Act. The waiver was submitted and this process is no longer relevant. The third paragraph is related to the GAP waiver, which no longer exists since that population is now fully enrolled in Medicaid.
•
Require Medicaid Supplemental Payments to Private Hospitals General Assembly Adjustment
  This amendment establishes the Medicaid Supplemental Payment Program Fund and requires the Department of Medical Assistance Services to accept and to pay into the fund, from any county, city, or town provider, assessment funds that have been collected, pursuant to an ordinance, from inpatient hospitals authorized to receive Medicaid supplemental payments pursuant to the State Plan for Medical Assistance Services amendments 11-018 and 11-019.
•
Require Separate Freestanding Emergency Department Reporting General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to require freestanding emergency departments to bill for services separately than the main hospital for which they are affiliated.
•
Review Medicaid Peer Recovery Services General Assembly Adjustment
  This amendment adds language directing the Department of Medical Assistance Services to review and consider amending regulations related to peer recovery services and convene a stakeholder group to look at barriers to providing the services.
•
Revise Medicaid Expenditure Reporting Requirements General Assembly Adjustment
  This amendment revises language in the introduced budget related to quarterly reporting on Medicaid managed care data to the Department of Planning and Budget, and the House Appropriations and Senate Finance and Appropriations Committees. It requires that expenditures be reported by program and service category and the data be summarized by service date for each quarter in the fiscal year and the previous two fiscal years and the report be made available on the Department of Medical Assistance Services website.
•
Unallot general fund FMAP savings (Reconvened Amendment) General Assembly Adjustment
  Requires that DMAS identify all state savings associated with the federal government increasing the FMAP rate (to 56.2%) for medical assistance services.  Further, DPB is authorized to unallot an amount of state funds equal to the general fund savings identified by DMAS.
•
Unallot spending increases in response to potential revenue shortfall (Reconvened Amendment) General Assembly Adjustment
  Creates a language item to require the unallotment of new discretionary spending amounts ($79,572,610 in FY 2021 and $127,501,107 in FY 2022).


p3_bullets - Official Enacted Budget - 06-07-2025 07:19:34