| • |
| 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 as projected by the Department of Medical Assistance Services. |
| |
| |
FY 2025 |
FY 2026 |
| General Fund |
$336,971,303 |
$295,242,919 |
| Nongeneral Fund |
$1,243,456,301 |
$845,881,485 |
|
| • |
| 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 as projected by the Department of Medical Assistance Services. |
| |
| |
FY 2025 |
FY 2026 |
| General Fund |
$22,386,335 |
$25,248,805 |
| Nongeneral Fund |
$41,664,848 |
$44,098,221 |
|
| • |
| Adjust Health Care Fund appropriation |
Decision Package |
|
| |
Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. |
| |
| |
FY 2025 |
FY 2026 |
| General Fund |
($48,845,662) |
$15,460,000 |
| Nongeneral Fund |
$48,845,662 |
($15,460,000) |
|
| • |
| Fund Family Access to Medical Insurance Security utilization and inflation |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$18,469,990 |
$22,211,865 |
| Nongeneral Fund |
$33,003,841 |
$35,441,604 |
|
| • |
| Authorize implementation of 1115 serious mental illness waiver |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$162,825 |
$998,595 |
| Nongeneral Fund |
$337,175 |
$2,521,478 |
| Positions |
0.00 |
1.00 |
|
| • |
| Comply with federal eligibility and processing rules |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$715,000 |
$0 |
| Nongeneral Fund |
$1,965,000 |
$0 |
|
| • |
| Cover pre-release Medicaid services for justice involved youth |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$0 |
$367,178 |
| Nongeneral Fund |
$1,000,000 |
$855,026 |
|
| • |
| Fund the cost of 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 2025 |
FY 2026 |
| General Fund |
($863,103) |
($695,709) |
|
| • |
| Unbundle long-acting injectables for serious mental illness |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$0 |
$177,906 |
| Nongeneral Fund |
$0 |
$1,302,361 |
|
| • |
| Ensure compliance with state and federal developmental disability waiver requirements |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$150,000 |
$239,289 |
| Nongeneral Fund |
$850,000 |
$239,289 |
| Positions |
0.00 |
4.00 |
|
| • |
| Fund administrative contract escalation costs |
Decision Package |
|
| |
Provides funding to cover the anticipated cost of volume driven contracts as well as actuarial services. |
| |
| |
FY 2025 |
FY 2026 |
| General Fund |
$0 |
$390,567 |
| Nongeneral Fund |
$0 |
$711,517 |
|
| • |
| Create a funding reserve for Medicaid initiatives |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$0 |
$972,941 |
|
| • |
| Allow children served in psychiatric residential treatment facilities to remain enrolled in managed care |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$0 |
$273,575 |
| Nongeneral Fund |
$0 |
$290,568 |
|
| • |
| Provide funding for Virginia Task Force on Primary Care |
Decision Package |
|
| |
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 2025 |
FY 2026 |
| General Fund |
$250,000 |
$0 |
| Nongeneral Fund |
$250,000 |
$0 |
|
| • |
| Clarify third party liability rules |
Decision Package |
|
| |
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. |
| • |
| Clarify the removal of cost sharing in existing Appropriation Act language |
Decision Package |
|
| |
Clarifies that current Appropriation Act language prohibiting cost sharing in Medicaid applies to co-insurance and deductibles. |
| • |
| Update nursing facility reimbursement methodology |
Decision Package |
|
| |
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. |
| • |
| Modify managed care contract language |
Decision Package |
|
| |
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. |
| • |
| Increase payments for psychiatric and obstetric-gynecological graduate medical residencies |
Decision Package |
|
| |
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. |
| • |
| Allow for an hourly adult day health care rate |
Decision Package |
|
| |
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. |
| • |
| Authorize final exempt authority to update reimbursement regulations |
Decision Package |
|
| |
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. |
| • |
| Clarify spending on mail room operations |
Decision Package |
|
| |
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. |
