Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the Board of Medical Assistance Services intends to consider promulgating 12VAC30-121, Medicare-Medicaid Demonstration Waivers and amending 12VAC30-50, Amount, Duration, and Scope of Medical and Remedial Care Services. The purpose of the proposed action is to create the Commonwealth Coordinated Care program, which enables individuals who are eligible for both Medicare and Medicaid services (dual eligibles) to receive acute, primary, and long-term care services in a coordinated managed care system.

The dual eligible population is of particular interest for a managed care program because the participants represent some of the most vulnerable citizens who typically have extensive medical, behavioral health, social, and long-term care needs. In the Commonwealth, dual eligibles are currently excluded from managed care because Medicare, being their first payer of services, covers their acute care services. Also, managed care organizations did not originally cover long-term care services (neither nursing facility services nor home and community-based services). These dual eligible persons have been receiving acute and long-term care services in Medicaid's fee-for-service system.

As a result of being in the fee-for-service system, no single health care provider or entity is responsible for coordinating all of these individuals' care, resulting in an inefficient system that is cumbersome for the individuals with misaligned benefit structures and opportunities for cost shifting. This system has likely led to unnecessary hospital admissions, unnecessary use of nursing facilities, and the mismanagement of medications.

Integrating primary and acute care services with long-term care and behavioral health services into one delivery system will streamline the delivery of services by offering ongoing access to quality health and long-term care services, care coordination, and referrals to appropriate community resources. This will also empower the Commonwealth's full dual eligible beneficiaries to remain independent, residing in settings of their choice for as long as possible.

The Social Security Act (§ 1932(a)) permits the combining of Medicare and Medicaid services to dual eligible individuals under the authority of a Financial Administration Demonstration Waiver. The goal of this action is to provide integrated care to dual eligible individuals who are currently excluded from participating in managed care programs. This change will enable these participants to access their primary, acute, behavioral health, and long-term care services through a single managed delivery system, thereby increasing the coordination of services across the spectrum of care.

Commonwealth Coordinated Care (CCC) Program participants will include adult full benefit dual eligible individuals (ages 21 and older), including full benefit dual eligible individuals in the Elderly or Disabled with Consumer Direction (EDCD) Waiver and full benefit dual eligible individuals residing in nursing facilities. Individuals who are required to "spend down" income in order to meet Medicaid eligibility requirements will not be eligible. The CCC Program also will not include individuals for whom DMAS only pays a limited amount each month toward their cost of care (e.g., deductibles only) such as: (i) qualified Medicare beneficiaries (QMBs); (ii) special low income Medicare beneficiaries (SLMBs); (iii) qualified disabled working individuals (QDWIs); or (iv) qualified individuals (QIs).

The proposed regulatory action will allow DMAS to combine certain aspects of managed care, long-term care, and Medicare into one program. The program is expected to offer participants care coordination, which will, it is anticipated, improve their quality of care. To accomplish this, DMAS is including certain populations and certain services previously excluded from managed care into a new managed care program. This new managed care program is being offered on a voluntary basis in five regions of the Commonwealth: Central Virginia, Tidewater, Northern Virginia, Charlottesville/Western, and the Roanoke region. The program has been phased in on a regional basis over the first 12 months of the program, starting with the Central Virginia and Tidewater regions. Eligible individuals were notified of the opportunity to enroll during March 2014 and the first opportunity for enrollment was effective on April 1, 2014. The remaining three regions were phased in later in 2014.

Covered services will include the following:

1. All Medicare Parts A, B, and D services (including inpatient, outpatient, durable medical equipment (DME), skilled nursing facilities (NFs), home health, and pharmacy);

2. The majority of Medicaid State Plan services that are not covered by Medicare, including behavioral health and transportation services;

3. Medicaid-covered EDCD Waiver services: adult day health care, personal care (consumer and agency directed), respite services (consumer and agency directed), personal emergency response system (PERS), transition coordination, and transition services;

4. Personal care services for persons enrolled in the Medicaid Works program;

5. Nursing facility services; and

6. Flexible benefits that will be at the option of participating plans.

The agency does not intend to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: § 32.1-325 of the Code of Virginia; §§ 1932 and 1915(c) of the Social Security Act.

Public Comment Deadline: October 7, 2015.

Agency Contact: Matthew Behrens, Project Manager, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 625-3673, FAX (804) 786-1680, or email matthew.behrens@dmas.virginia.gov.

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the Board of Medical Assistance Services intends to consider amending 12VAC30-141, Family Access to Medical Insurance Security Plan. The purpose of the proposed action is to grant eligibility to applicable qualified state employees or their dependents who are otherwise eligible to enroll in the FAMIS MOMs program to be enrolled in the program. Current regulations exclude state employees who have access to subsidized health insurance coverage from enrolling in the FAMIS MOMS program, even if they are otherwise eligible by income and residency. This amendment will only affect state employees who are qualified for employer-sponsored health insurance; wage employees are not eligible to receive a state contribution toward the cost of their health coverage.

The agency does not intend to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: § 32.1-351 of the Code of Virginia; Title XXI of the Social Security Act.

Public Comment Deadline: October 7, 2015.

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.

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the Virginia Board for Asbestos, Lead, and Home Inspectors intends to consider amending 18VAC15-40, Virginia Certified Home Inspectors Regulations. The certified home inspector program is a voluntary regulatory program administered by the Board for Asbestos, Lead, and Home Inspectors. Chapter 411 of the 2015 Acts of Assembly requires anyone who conducts a home inspection on a new residential structure to be certified by the board and to have successfully completed a training module developed by the board in conjunction with the Department of Housing and Community Development. The training module must be based on the International Residential Code component of the Virginia Uniform Statewide Building Code. Certification would become mandatory for those individuals who wish to conduct a home inspection on new residential structures. The board is required to develop regulation to implement Chapter 411 of the 2015 Acts of Assembly for implementation on July 1, 2016. The act further requires the board to develop the training module prior to July 1, 2016, and make such training module available for use in accordance with Chapter 411.

The agency intends to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: §§ 54.1-201 and 54.1-501 of the Code of Virginia.

Public Comment Deadline: October 7, 2015.

Agency Contact: Trisha L. Henshaw, Executive Director, Virginia Board for Asbestos, Lead, and Home Inspectors, 9960 Mayland Drive, Suite 400, Richmond, VA 23233, telephone (804) 367-8595, FAX (804) 350-5354, or email alhi@dpor.virginia.gov.

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the State Board of Social Services has WITHDRAWN the Notice of Intended Regulatory Action for 22VAC40-185, Standards for Licensed Child Day Centers, and 22VAC40-186, Standards for Licensed Child Day Centers, which was published in 29:3 VA.R. 341 October 8, 2012.

Agency Contact: Debra O'Neill, Child Care Consultant, Department of Social Services, 801 East Main Street, Richmond, VA 23219, telephone (804) 726-7648, FAX (804) 726-7132, or email debra.oneill@dss.virginia.gov.

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the State Board of Social Services has WITHDRAWN the Notice of Intended Regulatory Action for 22VAC40-185, Standards for Licensed Child Day Centers, and 22VAC40-186, Standards for Licensed Child Day Centers, which was published in 29:3 VA.R. 341 October 8, 2012.

Agency Contact: Debra O'Neill, Child Care Consultant, Department of Social Services, 801 East Main Street, Richmond, VA 23219, telephone (804) 726-7648, FAX (804) 726-7132, or email debra.oneill@dss.virginia.gov.

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the State Board of Social Services intends to consider amending 22VAC40-295, Temporary Assistance for Needy Families (TANF). The current regulation describes fair hearings and administrative disqualification hearings. While those are different types of hearings, the current regulation can be interpreted as meaning fair hearings and administrative disqualification hearings are the same. The agency proposes amending 22VAC40-295-140 to provide further clarification regarding the interplay between the two hearing processes and eliminate the misunderstanding about these separate processes.

The agency does not intend to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: § 63.2-217 of the Code of Virginia.

Public Comment Deadline: October 7, 2015.

Agency Contact: Bridget Shelmet, Department of Social Services, 801 East Main Street, Richmond, VA 23219, telephone (804) 726-7144, FAX (804) 726-7357, or email bridget.shelmet@dss.virginia.gov.