| • |
|
| |
Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent expenditure forecast as projected by the Department of Medical Assistance Services. |
| |
| |
FY |
FY |
| General Fund |
$336,971,303 |
$295,242,919 |
| Nongeneral Fund |
$1,243,456,301 |
$845,881,485 |
|
| • |
|
| |
Adjusts funding for the Commonwealth's Medicaid Children's Health Insurance Program to reflect the latest expenditure forecast as projected by the Department of Medical Assistance Services. |
| |
| |
FY |
FY |
| General Fund |
$22,386,335 |
$25,248,805 |
| Nongeneral Fund |
$41,664,848 |
$44,098,221 |
|
| • |
|
| |
Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. |
| |
| |
FY |
FY |
| General Fund |
($48,845,662) |
$15,460,000 |
| Nongeneral Fund |
$48,845,662 |
($15,460,000) |
|
| • |
|
| |
Adjusts funding for the Family Access to Medical Insurance Security program to reflect the latest forecast of expenditures as projected by the Department of Medical Assistance Services. |
| |
| |
FY |
FY |
| General Fund |
$18,469,990 |
$22,211,865 |
| Nongeneral Fund |
$33,003,841 |
$35,441,604 |
|
| • |
|
| |
Authorizes coverage for services provided to Medicaid beneficiaries during short-term stays (not to exceed 60 days) for acute care in psychiatric hospitals or residential treatment settings that qualify as Institutes of Mental Disease through an 1115 serious mental illness (SMI) waiver. Resources are also provided to support the cost of implementing and overseeing services provided through the SMI waiver. Authority to reappropriate first year balances is also provided should program implementation costs run into 2026. |
| |
| |
FY |
FY |
| General Fund |
$162,825 |
$998,595 |
| Nongeneral Fund |
$337,175 |
$2,521,478 |
| Positions |
0.00 |
1.00 |
|
| • |
|
| |
Provides funding for eligibility and enrollment systems changes as part of implementing new federal rules. Final rules recently issued by the Centers for Medicare and Medicaid Services make a number of changes to the Commonwealth's application, eligibility determination, enrollment, and renewal processes. This funding is necessary to comply with these federal requirements. |
| |
| |
FY |
FY |
| General Fund |
$715,000 |
$0 |
| Nongeneral Fund |
$1,965,000 |
$0 |
|
| • |
|
| |
Authorizes the provision of covered services, including screenings, diagnostic services, and targeted case management, in the 30 days pre-release and immediately post-release to eligible incarcerated youth and young adults in accordance with section 5121 of the federal Consolidated Appropriations Act of 2023. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$367,178 |
| Nongeneral Fund |
$1,000,000 |
$855,026 |
|
| • |
|
| |
Adjusts funding for the projected cost of hospital and physician services for persons subject to an involuntary mental commitment. |
| |
| |
FY |
FY |
| General Fund |
($863,103) |
($695,709) |
|
| • |
|
| |
Requires the payment of medical assistance, outside the hospital daily rate, for long-acting injectable or extended-release medications administered for a serious mental illness in any hospital emergency department or hospital inpatient setting. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$177,906 |
| Nongeneral Fund |
$0 |
$1,302,361 |
|
| • |
|
| |
Provides resources to ensure the department is able to comply with state and federal waiver requirements associated with contract monitoring, quality reviews and rules changes. Authority to reappropriate first year balances is also provided should implementation costs run into 2026. |
| |
| |
FY |
FY |
| General Fund |
$150,000 |
$239,289 |
| Nongeneral Fund |
$850,000 |
$239,289 |
| Positions |
0.00 |
4.00 |
|
| • |
|
| |
Provides funding to cover the anticipated cost of volume driven contracts as well as actuarial services. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$390,567 |
| Nongeneral Fund |
$0 |
$711,517 |
|
| • |
|
| |
Ensures sufficient general fund appropriation in future biennia by creating a funding reserve mechanism for the Medicaid program to account for projected but unbudgeted costs of new initiatives. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$972,941 |
|
| • |
|
| |
Enables children served in psychiatric residential treatment facilities (PRTF) to maintain their enrollment in managed care during their treatment. The payment for PRTF per diem payments and PRTF required services will be carved out of the managed care contract and paid as a fee-for-service benefit. No service eligible for reimbursement through the Children’s Services Act will be included in managed care. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$273,575 |
| Nongeneral Fund |
$0 |
$290,568 |
|
| • |
|
| |
Provides funding to contract with the Virginia Task Force on Primary Care to conduct research that guides Medicaid policy as it relates to primary health care. |
| |
| |
FY |
FY |
| General Fund |
$250,000 |
$0 |
| Nongeneral Fund |
$250,000 |
$0 |
|
| • |
|
| |
Provides authority for the Department of Medical Assistance Services to change the reimbursement methodology for adult day health care from a daily rate to an hourly rate. Any reimbursement rate adjustments must be budget neutral and not necessitate additional expenditures that exceed the amounts currently appropriated for this service. |
| • |
|
| |
Provides authority to submit final exempt regulatory packages to repeal existing provider reimbursement regulations (12 VAC 30-70, 12 VAC 30-80, and 12 VAC 30-90) and replace them with text identical to the Medicaid state plan text in effect on March 1, 2025. |
| • |
|
| |
Adds language to identify funding that was previously provided for mail room services. The 2024 General Assembly added funding for the Department of Medical Assistance Services to contract with a vendor to handle all incoming medical assistance-related mail currently directed to local departments of social services. Authority to reappropriate first year balances is also provided should implementation costs run into 2026. |
| • |
|
| |
Clarifies that current Appropriation Act language prohibiting cost sharing in Medicaid applies to co-insurance and deductibles. |
| • |
|
| |
Meets a federal requirement that Virginia has a rule in place to bar liable third-party payers from refusing payment solely on the basis that such item or service did not receive prior authorization under the third-party payer's rules. This policy has already been implemented by the Department of Medical Assistance Services and is not expected to have any fiscal or programmatic impact. |
| • |
|
| |
Increases graduate medical education supplemental payments for all qualifying psychiatric and obstetric-gynecological residencies to $150,000 annually effective July 1, 2026. In addition, program language is updated to reflect the latest information on residency program cohorts. |
| • |
|
| |
Allows the Department of Medical Assistance Services to implement managed care changes in future contract amendments that are currently authorized as part of reprocurement. Language also allows for the competitive procurement of a foster care specialty plan and technical changes necessary to implement authorized behavioral health initiatives. |
| • |
|
| |
Modifies the nursing facility reimbursement methodology described in 12 VAC 30-90-44 to use a Patient-Driven Payment Model instead of Resource Utilization Groups. This change to reimbursement methodology will be implemented in a budget neutral manner no later than October 1, 2025. |
| • |
|
| |
This amendment adds $6.9 million from the general fund and $39.8 million from nongeneral funds the second year and language to provide Medicaid coverage for weight loss medications in the Medicaid program under certain instances. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$6,858,938 |
| Nongeneral Fund |
$0 |
$39,829,380 |
|
| • |
|
| |
This amendment clarifies Medicaid reimbursement polices related to payment for services provided to tribal and non-tribal members through Tribal Health Clinics. |
| |
| |
FY |
FY |
| General Fund |
$0 |
($30,411,804) |
| Nongeneral Fund |
$0 |
($6,957,850) |
|
| • |
|
| |
This amendment provides $10.0 million from the general fund and $11.7 million from the nongeneral fund the second year to increase Medicaid rates for nursing facilities. Currently, the Medicaid rate setting process assumes full direct care cost coverage for approximately 50 percent of the days for which Medicaid covers, with the remaining Medicaid days reimbursed below cost; this increase would move that to approximately 59 percent of Medicaid days reimbursed at full cost for direct care. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$10,000,000 |
| Nongeneral Fund |
$0 |
$11,650,000 |
|
| • |
|
| |
This amendment provides $1.1 million from the general fund and $7.0 million from nongeneral funds the second year to support a 6.5 percent rate increase for Substance Use Disorder services. These services are Office Based Addiction Treatment, Opioid Treatment Services, Partial Hospitalization Services, and Intensive Outpatient Services. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$1,112,831 |
| Nongeneral Fund |
$0 |
$7,041,468 |
|
| • |
|
| |
This amendment provides $1.6 million from the general fund and $3.1 million from nongeneral funds the second year to provide Medicaid coverage for neurobehavioral and neurorehabilitation facilities to support 20 individuals with traumatic brain injuries and neurocognitive disorders by January 1, 2026. Language provides for the adoption of emergency regulations to effect such change. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$1,589,297 |
| Nongeneral Fund |
$0 |
$3,080,226 |
|
| • |
|
| |
This amendment redirects $865,000 from the general fund and $2.8 million from the nongeneral fund the first year provided in the introduced budget. |
| |
| |
FY |
FY |
| General Fund |
($865,000) |
$0 |
| Nongeneral Fund |
($2,815,000) |
$0 |
|
| • |
|
| |
This amendment provides $3.5 million from nongeneral funds the second year to provide Medicaid supplemental payments to the Virginia Commonwealth University (VCU) School of Dentistry for services provided by dentists it employs or with whom it contracts. VCU shall provide the non-federal share in order to match federal Medicaid funds for the supplemental payments. |
| |
| |
FY |
FY |
| Nongeneral Fund |
$0 |
$3,522,726 |
|
| • |
|
| |
Requires the Department of Medical Assistance Services to create a pilot program for mobile clinics within maternal health deserts in Virginia. The department must also evaluate the program's effectiveness and explore options for transitioning it to managed care organizations. This initiative is moved from the Virginia Department of Health. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$1,250,000 |
| Nongeneral Fund |
$0 |
$1,250,000 |
|
| • |
|
| |
This amendment provides $491,638 from the general fund and $1.5 million from nongeneral funds the second year to fund Medicaid coverage for a Continuous Glucose Monitor (CGM) and related supplies for the treatment of a Medicaid enrollee under the Medicaid medical and pharmacy benefit. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$491,638 |
| Nongeneral Fund |
$0 |
$1,507,096 |
|
| • |
|
| |
This amendment provides $550,322 from the general fund and $782,108 from nongeneral funds the second year to fund the fiscal impact of legislation to reimburse all licensed midwives at the same rate at 100.0 percent of the physician fee schedule for covered services. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$550,322 |
| Nongeneral Fund |
$0 |
$782,108 |
|
| • |
|
| |
This amendment provides $500,000 from the general fund and $500,000 from nongeneral funds the first year and language directing the Department of Medical Assistance Services to engage an independent consultant to conduct a comprehensive analysis of the costs and benefits and other considerations associated with the implementation of a single third-party administrator to serve as the pharmacy benefit manager for all Medicaid pharmacy benefits. Language provides authority to carryover funding for the analysis from fiscal year 2025 to fiscal year 2026 in the event the funds are not expended in the first year. |
| |
| |
FY |
FY |
| General Fund |
$500,000 |
$0 |
| Nongeneral Fund |
$500,000 |
$0 |
|
| • |
|
| |
This amendment eliminates the funding associated with the proposed Medicaid Reserve for Medicaid Initiatives in the introduced budget. The purpose of the initiative was to address the issue that, when initially funded, the full cost of policy changes to the Medicaid program are not recognized and that a reserve based on the projected incremental cost of the fully implemented policy change ensures that the base appropriation for the Medicaid program, the largest budget driver in the state budget, would better reflect past actions and reduce the future budget need that otherwise would be reflected in future Medicaid forecasts. While this amendment does remove the initiative, it also creates a workgroup to further evaluate the concept. |
| |
| |
FY |
FY |
| General Fund |
$0 |
($972,941) |
|
| • |
|
| |
This amendment adds $142,593 from the general fund and $428,713 from nongeneral funds the second year to modify Medicaid reimbursement for long-acting injectable or extended release medications administered in an any hospital emergency department or hospital inpatient setting for substance use disorder. The payment will be unbundled from the hospital daily rate. The introduced budget provides funding and language to unbundle these payments only when administered for a serious mental illness. This language extends this provision for cases of substance use disorder. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$142,593 |
| Nongeneral Fund |
$0 |
$428,713 |
|
| • |
|
| |
This amendment adds $235,000 from the general fund and $235,000 from nongeneral funds the first year to amend the Medicaid application across all eligibility modalities to gather all necessary information to determine an applicant's eligibility for the Medicaid Works program, pursuant to the passage of House Bill 1804, during the 2025 Regular Session. Funding is provided in the first year to allow systems changes to begin in order to implement the legislation on time. Language provides authority to carryover funding from fiscal year 2025 to fiscal year 2026 in the event the funds are not fully expended in the first year. |
| |
| |
FY |
FY |
| General Fund |
$235,000 |
$0 |
| Nongeneral Fund |
$235,000 |
$0 |
|
| • |
|
| |
This amendment provides $159,500 from the general fund the second year for the implementation of House Bill 1929 and Senate Bill 1393 passed during the 2025 Session, which directs the Virginia Department of Medical Assistance Services to create a membership-based mobile application available to prenatal, pregnant, and postpartum individuals who are eligible for Medicaid. |
| |
| |
FY |
FY |
| General Fund |
$0 |
$159,500 |
|
| • |
|
| |
This amendment clarifies that in the conversion from a daily rate to an hourly rate, the hourly rate for adult day care services is limited to no more than six hours per day. |
| • |
|
| |
This amendment clarifies that provider rate studies may only be conducted after specific authorization by the General Assembly. In addition, it authorizes a rate study of certain Developmental Disabilities Services. |
| • |
|
| |
This amendment directs the Department of Medical Assistance Services to make efforts to ensure that pregnant women that apply for Medicaid coverage utilize the Cover Virginia call center, to the maximum extent possible, in order to reduce the processing time of the application and expedite the applicant into coverage. |
| • |
|
| |
This amendment requires the Department of Medical Assistance Services (DMAS) to develop cost estimates for the options proposed in the 'Evaluation of Medicaid Eligibility Determination' report. In addition, DMAS and the Department of Social Services are directed to establish a formal joint Steering Committee on Medicaid Eligibility. |
| • |
|
| |
Clarifies that services provided to non-tribal members should be paid based on the DMAS standard rate methodology. |
| • |
|
| |
This amendment allows public institutions participating in the private hospital supplemental payment program to hire legal counsel to assist in the complex legal arrangements necessary to participate in the program. |
| • |
|
| |
This amendment adds language requiring more detailed reporting of Medicaid expenditures on a monthly basis to the Department of Planning and Budget and the Chairs of the House Appropriations and Senate Finance and Appropriations Committees. Current language in Chapter 2, 2024 Special Session I, requires monthly expenditure reports on the Medicaid program. This language would require service level detail to be included. Language directs DMAS to report on cost-effectiveness strategies for the Medicaid and the children's health insurance programs. Language also requires a fiscal analysis of policy or programmatic changes to the Medicaid and children's health insurance programs and restricts implementation unless funding is authorized through an appropriation by the General Assembly, a statutory requirement or federal law. In addition, language is added to provide greater transparency of Medicaid policy and programmatic changes on the Department of Medical Assistance Services' website. |
| • |
|
| |
This amendment adds language requiring the Pharmacy and Therapeutics Committee to ensure that any non opioid drug approved by the federal Food and Drug Administration shall be considered for safety and clinical efficacy and cost effectiveness pursuant to requirements set forth in the Virginia Administrative Code. Language is also added requiring the Department of Medical Assistance Services to conduct a fiscal impact review on recommendations from the Pharmacy and Therapeutics Committee that would result in changes to the program's Common Core Formulary. In addition, it requires that the Pharmacy and Therapeutics Committee include as part of its membership one physician or pharmacist from each contracted managed care organization. |
| • |
|
| |
This amendment provides the Department of Medical Assistance Services (DMAS) with the authority to implement supplemental Medicaid payments to teaching hospitals affiliated with the Virginia Tech Carilion School of Medicine based on the department's reimbursement methodology established for such payments and/or its contracts with managed care organizations. The state's share of funding for the supplemental payments shall be provided by the Virginia Tech Carilion School of Medicine. A companion amendment in Item 211 authorizes the transfer of funds from this school to DMAS for this purpose. |
| • |
|
| |
This amendment provides that the amounts withheld from the managed care rates for the Performance Withhold Program and the Clinical Efficiencies program shall be fully paid in fiscal year 2025 to the Medicaid managed care organizations (MCOs). This is a one year suspension to provide financial relief to the MCOs that are experiencing higher costs from increased acuity in the Medicaid population. |
| • |
|
| |
This amendment redistributes funding for poison control center services from three centers to two. The National Capitol Poison Control Center is ceasing operations as of March 31, 2025, and the poison control centers operated by the two state teaching hospitals will provide poison control services to the Northern Virginia region. |
| • |
|
| |
This amendment provides authority for the Department of Medical Assistance Services to require provider appeals to be filed only online through the department's appeal portal. |
| • |
|
| |
This amendment is a technical language change that sets the purpose of the appropriation provided in last year's adopted budget related to improving processes for timely and accurate Medicaid eligibility determinations and redeterminations. In addition, the Department of Planning and Budget must unallot this appropriation until the Department of Medical Assistance Services provides documentation of the contract's cost and can only allot the amount contracted for with such vendor. |
| • |
|
| |
This amendment modifies the external financial review committee for Medicaid to enhance monitoring of expenditures and enrollment growth to determine the program's financial status on a comprehensive and regular basis. |
| • |
|
| |
This amendment directs the Department of Medical Assistance Services to establish objective and measurable performance measures for acute care hospitals that are receiving private acute care hospital enhanced payments. These measures shall assess whether the additional payments improve services for Medicaid members. |
| • |
|
| |
This amendment makes technical changes to language in the introduced budget related to Medicaid Graduate Medical Education residency and fellowship slots funded by the state at the Children's Hospital of the King's Daughters to accurately reflect the number of residency and fellowship slots funded through the program. |
| • |
|
| |
This amendment adds language directing the Department of Medical Assistance Services to work with stakeholders to develop recommendations on modifying the timing and structure of the value-based payments that are made to nursing facilities based on the achievement of certain performance metrics. |
