Title of Regulation: 12VAC30-40. Eligibility Conditions and Requirements (amending 12VAC30-40-250).

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: June 14, 2017.

Effective Date: June 29, 2017.

Agency Contact: Emily McClellan, Regulatory Supervisor, Policy Division, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, FAX (804) 786-1680, or email emily.mcclellan@dmas.virginia.gov.

Basis: Section 32.1-325 of the Code of Virginia grants to the Board of Medical Assistance Services the authority to administer and amend the Plan for Medical Assistance, and § 32.1-324 of the Code of Virginia authorizes the Director of the Department of Medical Assistance Services (DMAS) to administer and amend the Plan for Medical Assistance according to the board's requirements. The Medicaid authority as established by § 1902(a) of the Social Security Act (42 USC § 1396a) provides governing authority for payments for services.

Purpose: The purpose of this action is to implement the changes required by Chapter 567 of the 2016 Acts of Assembly, which states that DMAS shall provide Medicaid coverage to auxiliary grant recipients living in approved supportive housing. Additionally, DMAS shall "seek to amend the state plan for medical assistance under Title XIX of the Social Security Act, and any waivers thereof, to implement the necessary changes pursuant to the provisions of this act."

Currently, the only approved residential settings for auxiliary grant recipients are assisted living facilities and adult foster homes. Chapter 567 adds supportive housing as an approved residential setting for auxiliary grant recipients. A new payment category (reasonable classification) is added to 12VAC30-40-250 in the state plan to achieve this purpose. Maximum rates for homes in the existing payment categories are updated to reflect the current rates.

The amendments provide Medicaid coverage to individuals residing in approved supportive housing and add supportive housing as a third approved residential setting option for auxiliary grant recipients, who automatically qualify for Medicaid. This action will allow auxiliary grant recipients to reside in a setting best suited to their needs. The amendments improve clarity for the public.

Rationale for Using Fast-Track Rulemaking Process: This regulatory action is being promulgated as a fast-track rulemaking action because it is not expected to be controversial. Further, there will be no fiscal or budgetary impact to DMAS, as the funds for this amendment are already provided in the agency's appropriations. As this action provides Medicaid coverage to individuals residing in assisted living housing, members of the public are expected to support these regulatory changes that may positively impact a disadvantaged population.

Substance: With respect to eligibility conditions and requirements, these regulatory amendments will provide Medicaid coverage to individuals residing in approved supportive housing.

Issues: The advantage of this regulatory action is that it enhances Medicaid eligibility by providing a comprehensive service plan of care for auxiliary grant recipients living in approved supportive housing. This action is advantageous to the public. This action does not generate a disadvantage to the public or to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. On behalf of the Board of Medical Assistance Services, the Director of the Department of Medical Assistance Services proposes to amend the regulation to reflect that Chapter 567 of the 2016 Acts of Assembly (Chapter 567)¹ added supportive housing² as a third approved residential setting for auxiliary grant³ recipients.

Result of Analysis. The proposed amendment creates a net benefit.

Estimated Economic Impact. Prior to Chapter 567, the only approved residential settings for auxiliary grant recipients were assisted living facilities and adult foster homes. The legislation adds supportive housing as a third approved residential setting option for auxiliary grant recipients. Auxiliary grant recipients automatically qualify for Medicaid. The proposed amendment does not in practice affect who qualifies for Medicaid, or where they may reside. Nevertheless, amending the regulation is moderately beneficial in that it improves clarity for the public.

Businesses and Entities Affected. The proposed amendment affects readers of this regulation who may have been misled into thinking that assisted living facilities and adult foster homes were the only approved residential settings for auxiliary grant recipients. Chapter 567 capped the number of auxiliary grant recipients in supportive housing at 60.

Localities Particularly Affected. The proposed amendment does not disproportionately affect specific localities.

Projected Impact on Employment. The proposed amendment does not affect total employment.  

Effects on the Use and Value of Private Property. The proposed amendment does not significantly affect the use and value of private property.

Real Estate Development Costs. The proposed amendment does not affect real estate development costs.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The proposed amendment does not affect costs for small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendment does not adversely affect small businesses.

Adverse Impacts:

Businesses. The proposed amendment does not adversely affect businesses.

Localities. The proposed amendment does not adversely affect localities.

Other Entities. The proposed amendment does not adversely affect other entities.

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¹See http://leg1.state.va.us/cgi-bin/legp504.exe?161+ful+CHAP0567

²"Supportive housing" is defined in Code of Virginia § 51.5-160 as "a residential setting with access to supportive services for an auxiliary grant recipient in which tenancy … is provided or facilitated by a provider licensed to provide mental health community support services, intensive community treatment, programs of assertive community treatment, supportive in-home services, or supervised living residential services that has entered into an agreement with the Department of Behavioral Health and Developmental Services."

³The Auxiliary Grants Program is a program to supplement income of an individual receiving Supplemental Security Income (SSI) or an adult who would be eligible for SSI except for excess income, who resides in an assisted living facility, adult foster care, or now due to Chapter 567, supportive housing.

Agency's Response to Economic Impact Analysis: The agency has reviewed the economic impact analysis prepared by the Department of Planning and Budget and concurs with this analysis.

Summary:

Pursuant to Chapter 567 of the 2016 Acts of Assembly, the amendments establish Medicaid coverage for auxiliary grant recipients residing in approved supportive housing.