• |
Provide health care coverage to the uninsured |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
($120,384,883) |
($221,410,214) |
Nongeneral Fund |
$926,114,992 |
$2,236,379,476 |
Positions |
15.00 |
15.00 |
|
• |
Fund Medicaid utilization and inflation |
Decision Package |
|
|
Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent forecast expenditures. |
|
|
FY 2019 |
FY 2020 |
General Fund |
$199,450,674 |
$384,421,932 |
Nongeneral Fund |
$334,394,964 |
$498,099,289 |
|
• |
Add waiver slots as required by the Department of Justice settlement agreement |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$14,504,043 |
$30,515,895 |
Nongeneral Fund |
$14,504,043 |
$30,515,895 |
|
• |
Fund Family Access to Medical Insurance Security utilization and inflation |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$3,849,858 |
$23,399,128 |
Nongeneral Fund |
$28,232,295 |
$19,253,975 |
|
• |
Correct Medicaid forecast to account for ACA tax and CSA spending |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
($22,426,441) |
$14,377,085 |
Nongeneral Fund |
($22,426,441) |
$14,377,085 |
|
• |
Rebase training center budgets to reflect anticipated closures |
Decision Package |
|
|
Adjusts the budget for state training center reimbursements to account for the on-going facility closure costs and savings resulting from compliance with the Department of Justice settlement agreement. This 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 2019 |
FY 2020 |
General Fund |
($10,547,486) |
($17,036,146) |
Nongeneral Fund |
($10,547,486) |
($17,036,146) |
|
• |
Adjust Health Care Fund appropriation |
Decision Package |
|
|
Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Tobacco taxes are projected to decrease by $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 2019 |
FY 2020 |
General Fund |
($12,220,660) |
($6,520,660) |
Nongeneral Fund |
$12,220,660 |
$6,520,660 |
|
• |
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. 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 2019 |
FY 2020 |
General Fund |
$1,921,446 |
$16,615,995 |
Nongeneral Fund |
$14,090,604 |
$4,571,074 |
|
• |
Adjust appropriation to reflect anticipated grant revenue |
Decision Package |
|
|
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 2019 |
FY 2020 |
Nongeneral Fund |
($16,000,000) |
($16,000,000) |
|
• |
Increase rates for consumer directed personal care, respite, and companion services |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$4,773,196 |
$5,055,102 |
Nongeneral Fund |
$4,773,196 |
$5,055,102 |
|
• |
Allow consumer-directed attendants to receive overtime pay for up to 56 hours |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$0 |
$9,609,223 |
Nongeneral Fund |
$0 |
$9,609,223 |
|
• |
Provide funding for Cover Virginia Call Center |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$3,750,000 |
$1,125,000 |
Nongeneral Fund |
$6,250,000 |
$3,375,000 |
|
• |
Fund medical services for involuntary mental commitments |
Decision Package |
|
|
Increases funding for the cost of hospital and physician services for persons subject to an involuntary mental commitment. The most recent forecast of expenditures projects higher costs than previously estimated. |
|
|
FY 2019 |
FY 2020 |
General Fund |
$3,022,906 |
$3,935,262 |
|
• |
Adjust appropriation for the centrally funded three percent salary increase for state employees |
Base Budget Adjustment |
|
|
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 2019 |
FY 2020 |
General Fund |
$1,694,025 |
$1,694,025 |
Nongeneral Fund |
$1,749,678 |
$1,749,678 |
|
• |
Fund Medicaid cost of adopting same day access in remaining community service boards |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$1,600,000 |
$1,600,000 |
Nongeneral Fund |
$1,600,000 |
$1,600,000 |
|
• |
Adjust appropriation for centrally funded health insurance costs |
Base Budget Adjustment |
|
|
Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 475 G. of Chapter 836, 2017 Acts of Assembly. |
|
|
FY 2019 |
FY 2020 |
General Fund |
$1,469,264 |
$1,469,264 |
Nongeneral Fund |
$1,506,557 |
$1,506,557 |
|
• |
Add reserve waiver slots |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$937,238 |
$1,874,475 |
Nongeneral Fund |
$937,238 |
$1,874,475 |
|
• |
Fund federally required independent External Quality Review Organization (EQRO) activities |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$301,755 |
$570,449 |
Nongeneral Fund |
$905,266 |
$1,711,348 |
|
• |
Reduce appropriation to reflect the impact of DSH cuts on state behavioral health facilities |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
($453,910) |
($635,474) |
Nongeneral Fund |
($453,910) |
($635,474) |
|
• |
Provide training for consumer-directed attendants |
Decision Package |
|
|
Funds training for consumer-directed attendants who provide personal assistance, respite, and companion services. |
|
|
FY 2019 |
FY 2020 |
General Fund |
$500,000 |
$500,000 |
Nongeneral Fund |
$500,000 |
$500,000 |
|
• |
Adjust appropriation for the centrally funded changes in agency information technology costs |
Base Budget Adjustment |
|
|
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 2019 |
FY 2020 |
General Fund |
$73,725 |
$73,725 |
Nongeneral Fund |
$658,403 |
$658,403 |
|
• |
Increase use of civil money penalty funds |
Decision Package |
|
|
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 2019 |
FY 2020 |
Nongeneral Fund |
$700,000 |
$700,000 |
|
• |
Adjust appropriation for centrally funded retirement rate changes |
Base Budget Adjustment |
|
|
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 2019 |
FY 2020 |
General Fund |
($331,956) |
($331,956) |
Nongeneral Fund |
($342,860) |
($342,860) |
|
• |
Adjust appropriation for the centrally funded two percent salary increase for high turnover positions |
Base Budget Adjustment |
|
|
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 2019 |
FY 2020 |
General Fund |
$255,956 |
$255,956 |
Nongeneral Fund |
$255,956 |
$255,956 |
|
• |
Provide eye care services to children in certain schools |
Decision Package |
|
|
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 2019 |
FY 2020 |
Nongeneral Fund |
$336,096 |
$336,096 |
|
• |
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 476 J. of Chapter 836, 2017 Acts of Assembly. |
|
|
FY 2019 |
FY 2020 |
General Fund |
$141,447 |
$141,447 |
Nongeneral Fund |
$157,955 |
$157,955 |
|
• |
Strengthen data security and compliance processes |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$138,087 |
$138,087 |
Nongeneral Fund |
$138,087 |
$138,087 |
Positions |
2.00 |
2.00 |
|
• |
Adjust appropriation for centrally funded workers’ compensation premium changes |
Base Budget Adjustment |
|
|
Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 475 V. of Chapter 836, 2017 Acts of Assembly. |
|
|
FY 2019 |
FY 2020 |
General Fund |
($133,860) |
($133,860) |
Nongeneral Fund |
($134,245) |
($134,245) |
|
• |
Replace lost federal match for information technology staff |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$0 |
$250,000 |
Nongeneral Fund |
$0 |
($250,000) |
|
• |
Adjust appropriation for centrally funded state employee other post-employment benefit rate changes |
Base Budget Adjustment |
|
|
Adjusts appropriation for changes in state employee other post-employment benefit rates budgeted in Central Appropriations, Item 475 K. of Chapter 836, 2017 Acts of Assembly. |
|
|
FY 2019 |
FY 2020 |
General Fund |
$109,138 |
$109,138 |
Nongeneral Fund |
$112,723 |
$112,723 |
|
• |
Fund increased cost of third party liability (TPL) verifications |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$104,175 |
$104,175 |
Nongeneral Fund |
$104,175 |
$104,175 |
|
• |
Fund mandated evaluation of the Governor’s Access Program (GAP) waiver |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$85,000 |
$85,000 |
Nongeneral Fund |
$85,000 |
$85,000 |
|
• |
Increase funding for children's enrollment services contract |
Decision Package |
|
|
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 2019 |
FY 2020 |
General Fund |
$11,280 |
$19,388 |
Nongeneral Fund |
$82,720 |
$74,612 |
|
• |
Adjust appropriation for centrally funded internal service fund charges for the Personnel Management Information System |
Base Budget Adjustment |
|
|
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 2019 |
FY 2020 |
General Fund |
$4,178 |
$4,178 |
Nongeneral Fund |
$4,684 |
$4,684 |
|
• |
Adjust appropriation for centrally funded changes in Cardinal charges |
Base Budget Adjustment |
|
|
Adjusts appropriation for the reduction in Cardinal charges budgeted in Central Appropriations, Item 476 L. of Chapter 836, 2017 Acts of Assembly. |
|
|
FY 2019 |
FY 2020 |
General Fund |
($1,064) |
($1,064) |
Nongeneral Fund |
($1,282) |
($1,282) |
|
• |
Provide notice of state plan and waiver amendments |
Decision Package |
|
|
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. |
• |
Add language to specify medical residencies awards |
Decision Package |
|
|
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. |
• |
Ensure the continued availability of Children's Services Act (CSA) payment data |
Decision Package |
|
|
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. |
• |
Update eligibility performance management program |
Decision Package |
|
|
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. |
• |
Move appropriation to reflect agency operations |
Decision Package |
|
|
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. |