Title of Regulation: 12VAC30-10. State Plan under Title XIX of the Social Security Act Medical Assistance Program; General Provisions (amending 12VAC30-10-40).

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

Effective Date: November 11, 2021.

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.

Background: Section 1902(a)(73) of the Social Security Act (42 USC § 1902) mandates that states in which an Indian health program or Urban Indian organization furnishes health care services establish a process for the state Medicaid agency, that is the Department of Medical Assistance Services (DMAS) in Virginia, to seek advice on a regular, ongoing basis from designees of the Indian health programs. Consultation is required concerning Medicaid matters having a direct impact on the Indian health programs. Virginia newly has an Indian health program that furnishes health care services, including services under Medicaid, for Pamunkey Tribe community members. DMAS must solicit advice prior to the submission of any plan amendments, waiver requests, and proposals for demonstration projects that are likely to have a direct effect on tribal members, Indian health programs, and Urban Indian organizations. DMAS has identified a program designee as an advisory contact through which the dissemination of information will occur.

Summary:

The amendments conform the regulation to a requirement of the Social Security Act for the state Medicaid agency to maintain interactive communication with any Indian health organizations or Urban Indian programs that provide health services to tribal members regarding Medicaid program changes that may likely have a direct effect on the administration of program services.

12VAC30-10-40. State Medical Care Advisory Committee.

A. There is an advisory committee to the Medicaid agency director on health and medical care services established in accordance with and meeting all the requirements of 42 CFR 413.12 431.12.

B. Tribal consultation. Section 1902(a)(73) of the Social Security Act requires a state in which one or more Indian health programs or Urban Indian organizations furnish health care services to establish a process for the state Medicaid agency to seek advice on a regular, ongoing basis from designees of Indian health programs, whether operated by the Indian Health Service, a Tribe, or Tribal organizations under the Indian Self-Determination and Education Assistance Act (P.L. 93-638) or Urban Indian Organizations under the Indian Health Care Improvement Act (25 USC § 1601 et seq.), concerning Medicaid matters having a direct impact on Indian health programs.

C. The Department of Medical Assistance Services (DMAS) seeks advice on an ongoing basis from federally recognized tribes, Indian health programs, and Urban Indian organizations on matters related to Medicaid and Children's Health Insurance Program programs. DMAS has identified a program designee as an advisory contact, through which, the dissemination of information will occur. Designees from each Tribe, Indian health program, and Urban Indian organization receive written communication from DMAS about State Plan amendments, waiver proposals, waiver extensions, waiver amendments, and waiver renewals before any of these documents are submitted to the Centers for Medicare and Medicaid Services. Tribes, Indian health programs, and Urban Indian organizations may request additional information and may request meetings to discuss the proposed changes. DMAS invites these groups to request additional information or offer comments on proposed changes within 30 days of the notification of State Plan amendments, waiver proposals, waiver extensions, waiver amendments, or waiver renewals. For emergency-related submissions, such as a natural disaster or a legislative mandate, DMAS seeks information requests, comments, or proposed changes within 15 days of notification. The coordination of this consultation process was established through an email communication with designees from each Tribe and Indian health program on January 29, 2021. To maintain a cooperative channel of communication and informative dialogue between DMAS and the Tribal organizations, the agency sought out and will continue to seek advice on a regular, ongoing basis via email, teleconference, or meetings.