| • |
| Fund Medicaid utilization and inflation |
Decision Package |
|
| |
Adjusts funding to reflect the cost of Medicaid as estimated in the most recent forecast expenditures. The majority of the first year reduction is associated with enhanced federal matching dollars being provided in the third quarter of fiscal year 2021. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($245,296,854) |
$17,935,388 |
| Nongeneral Fund |
$334,438,121 |
$499,977,179 |
|
| • |
| Adjust Health Care Fund appropriation |
Decision Package |
|
| |
Adjusts the appropriation in the Virginia Health Care Fund to reflect the latest revenue estimates. Since the Health Care Fund is used as state match for Medicaid, any increase in revenue offsets general fund support for Medicaid and likewise any decrease requires additional general fund support. The first year surplus is primarily related to a $45 million one-time cash balance to begin fiscal year 2021. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($53,910,131) |
($5,204,943) |
| Nongeneral Fund |
$53,910,131 |
$5,204,943 |
|
| • |
| Move reductions to agency budget |
Decision Package |
|
| |
Moves the reductions included in Item 482.20 of the 2020 Special Session Appropriation Act from Central Appropriations to the agency budget. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($63,443,772) |
($28,302,522) |
| Nongeneral Fund |
($1,522,168) |
($1,167,598) |
|
| • |
| 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. Forecast costs were primarily driven by higher than expected enrollment growth in the FAMIS program. However, that upward pressure was more than offset by lower managed care rates, higher pharmacy rebates and decreased service utilization. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($6,748,314) |
($3,426,109) |
| Nongeneral Fund |
($4,093,135) |
($4,041,509) |
|
| • |
| Adjust Medicaid forecast to account for revised Medicare premiums |
Decision Package |
|
| |
Accounts for Medicare premium rates that were published after the official Medicaid forecast was completed. During the development of the Medicaid forecast, due November 1, the Department of Medical Assistance Services had to use preliminary assumptions on Medicare premium rates. Since the forecast was finalized, the federal government has released actual Medicare Part A and B rates for effective January 1, 2021. The changes will allow the forecast to be lowered by $14.0 million total funds (over the biennium); thereby reducing the general fund need by $7.4 million. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($2,596,171) |
($4,801,416) |
| Nongeneral Fund |
($2,526,103) |
($4,112,466) |
|
| • |
| Fund medical assistance services for low-income children utilization and inflation |
Decision Package |
|
| |
Adjusts funding to reflect the latest forecast of utilization and inflation in the Commonwealth's Medicaid Children's Health Insurance program. Forecast costs were primarily driven by higher than expected enrollment growth. However, that upward pressure was more than offset by lower managed care rates, higher pharmacy rebates and decreased service utilization. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($3,041,042) |
($1,420,919) |
| Nongeneral Fund |
$5,457,670 |
$2,329,982 |
|
| • |
| Implement the Virginia Facilitated Enrollment Program |
Decision Package |
|
| |
Provides funding to support legislation being proposed in the 2021 General Assembly that will require the Virginia Department of Taxation to allow for the communication of taxation data to the Department of Medical Assistance Services and the Health Benefit Exchange to determine eligibility for Virginia's Medical Assistance program. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$1,166,180 |
| Nongeneral Fund |
$0 |
$6,959,211 |
| Positions |
0.00 |
4.00 |
|
| • |
| Fund managed care operational changes |
Decision Package |
|
| |
Provides funding to support managed care operational changes that are federally mandated. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$2,196,012 |
| Nongeneral Fund |
$0 |
$4,804,988 |
|
| • |
| Transfer funds to cover Medicaid related system modifications |
Decision Package |
|
| |
Moves appropriation from the Department of Medical Assistance Services to the Department of Social Services to cover the expected costs of Medicaid related modifications to the enterprise case management system. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($300,000) |
($300,000) |
| Nongeneral Fund |
($2,700,000) |
($2,700,000) |
|
| • |
| Provide support for federal interoperability and patient access requirements |
Decision Package |
|
| |
Provides funds to offset systems costs that will be incurred by managed care organizations in fiscal year 2022 as a result of complying with the federal requirements associated with the Interoperability and Patient Access Final Rule and the 21st Century Cures Act. Language is also included to remove one-time funding from future capitation rates.
|
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$1,739,306 |
| Nongeneral Fund |
$0 |
$3,805,694 |
|
| • |
| Fund medical services for involuntary mental commitments |
Decision Package |
|
| |
Adjusts funding for the projected cost of hospital and physician services for persons subject to an involuntary mental commitment. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($2,704,024) |
($2,337,239) |
|
| • |
| Fund doula services for pregnant women |
Decision Package |
|
| |
Provides authority and funding for the addition of a community doula benefit for pregnant Medicaid members. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$1,168,371 |
| Nongeneral Fund |
$0 |
$1,243,031 |
|
| • |
| Expand addiction treatment beyond opioid use disorder |
Decision Package |
|
| |
Provides funding to expand the Preferred Office-Based Opioid Treatment model to all members with any moderate to high-risk substance use disorder. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$881,306 |
| Nongeneral Fund |
$0 |
$1,296,254 |
|
| • |
| Cover COVID-19 vaccinations for non-expansion adults |
Decision Package |
|
| |
Funds the cost of COVID-19 vaccinations for non-expansion adults in the Medicaid fee-for-service and managed care programs. This action will ensure that all adult Medicaid members have access to COVID-19 vaccinations. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$995,742 |
| Nongeneral Fund |
$0 |
$995,742 |
|
| • |
| Account for third quarter of enhanced federal Medicaid match in facility budget |
Decision Package |
|
| |
Adjusts appropriation to account for the third quarter of enhanced federal matching dollars being provided for Medicaid costs incurred by state training centers. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($808,764) |
$0 |
| Nongeneral Fund |
$808,764 |
$0 |
|
| • |
| Authorize 12-month prescriptions of contraceptives for Medicaid members |
Decision Package |
|
| |
Allows eligible beneficiaries to receive up to a 12 month supply of prescription contraceptives. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$0 |
$136,533 |
| Nongeneral Fund |
$0 |
$1,380,694 |
|
| • |
| Implement federal client appeals requirements |
Decision Package |
|
| |
Adds funding to handle the increased workload associated with expanding the scope of the client appeal process per federal requirements. Seven appeals staff positions as well as the expected costs to managed care organizations are funded by this amendment. In addition, language is added that authorizes the agency to promulgate regulations that clarify several aspects of the appeals process. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$34,135 |
$598,763 |
| Nongeneral Fund |
$34,135 |
$823,476 |
|
| • |
| Transfer assisted living screening funds |
Decision Package |
|
| |
Moves general fund appropriation from the Department of Medical Assistance Services (DMAS) to the Department of Social Services to cover the assisted living facility screening being conducted by local departments of social services. In addition, the Department for Aging and Rehabilitative Services (DARS) is directed to modify regulations to remove obsolete language that identifies DMAS as being responsible for supporting this activity. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
($641,050) |
($641,050) |
|
| • |
| Comply with federal durable medical equipment requirements |
Decision Package |
|
| |
Broadens the definition of durable medical equipment (DME) to comply with federal rules. The federal mandate requires states to no longer limit DME to items primarily used in the home but rather extends to any setting where normal activities take place. |
| |
| |
FY 2021 |
FY 2022 |
| General Fund |
$68,014 |
$272,050 |
| Nongeneral Fund |
$76,146 |
$304,585 |
|
| • |
| Adjust appropriation and language for civil money penalty funds |
Decision Package |
|
| |
Modifies appropriation and language to reflect anticipated spending as federally approved in the latest Civil Money Penalty Reinvestment State Plan. In addition, the agency is permitted to request additional appropriation if amounts are insufficient to meet future federally approved activities. |
| |
| |
FY 2021 |
FY 2022 |
| Nongeneral Fund |
$225,000 |
$225,000 |
|
| • |
| Allow FAMIS MOMS to utilize substance abuse disorder treatment |
Decision Package |
|
| |
Provides funding to allow members enrolled in 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 2021 |
FY 2022 |
| General Fund |
$0 |
$13,497 |
| Nongeneral Fund |
$0 |
$25,067 |
|
| • |
| Make required adjustments to the graduate medical residency program |
Decision Package |
|
| |
Adds language to specify which hospitals have been awarded graduate medical residency slots from cohorts funded in the Act. In addition, all appropriation associated with the residency program is permanently moved to a new service area within the Department of Medical Assistance Services as required Act language. |
| • |
| Affirm Medicaid coverage of gender dysphoria related services |
Decision Package |
|
| |
Requires the department to modify agency policy manuals to affirm the coverage of gender dysphoria services for Medicaid members. |
| • |
| Allow pharmacy immunizations for covered services |
Decision Package |
|
| |
Authorizes the reimbursement of pharmacy-administered immunizations for all vaccinations covered under the medical benefit for Medicaid members. This change must be implemented using a budget neutral methodology. |
| • |
| Authorize the transfer of funds to account for cost shifts at the Commonwealth Center for Children and Adolescents |
Decision Package |
|
| |
Allows the transfer of general fund appropriation, as needed, between Item 313, Reimbursements to State-Owned Mental Health and Intellectual Disabilities Facilities (45607) and Item 326, State Mental Health Facility Services (43014) to address potential operational shortfalls at the Commonwealth Center for Children and Adolescents. This authority expires on July 1, 2021. |
| • |
| Add DBHDS licenses to ASAM Level 4.0 |
Decision Package |
|
| |
Adds language to reflect the Department of Behavioral Health and Developmental Services (DBHDS) licensing criteria for the American Society of Addiction Medicine (ASAM) Level of Care 4.0. |
| • |
| Move funds to cover the cost of implementing a live-in caretaker exemption |
Decision Package |
|
| |
Transfers appropriation between programs within the Department of Medical Assistance Services to cover the estimated cost of exempting live-in personal caretakers from electronic visit verification requirements as required by Appropriation Act language. As this transfer is permanent, the associated Act language is also removed. |
| • |
| Authorize post-public health emergency telehealth |
Decision Package |
|
| |
Authorizes telehealth coverage for clinically appropriate audio-only services, provider-to-provider consultations, store-and-forward, and virtual check-ins with patients. |
| • |
| Increase Medicaid reimbursements for veteran care centers |
Decision Package |
|
| |
Authorizes the Department of Medical Assistance Services to make supplemental payments to veterans care centers through the use of intergovernmental transfers. Through this arrangement it is estimated that veterans care centers could use facility revenue to generate approximately $2.3 million of additional Medicaid funding. No additional state support is required. |
