DEPARTMENT OF ENVIRONMENTAL QUALITY

Total Maximum Daily Loads for the South Fork Holston River, Bishop Branch, Grosses Creek, and Slemp Creek

The Department of Environmental Quality (DEQ) seeks written and oral comments from interested persons on the development of total maximum daily loads (TMDLs) for the South Fork Holston River, Bishop Branch, Grosses Creek, and Slemp Creek in Washington and Smyth Counties. These streams are listed on the 2012 § 303(d) TMDL Priority List and Report as impaired due to violations of the state's water quality standards for bacteria.

Section 303(d) of the Clean Water Act and § 62.1-44.19:7 C of the State Water Control Law requires DEQ to develop TMDLs for pollutants responsible for each impaired water contained in Virginia's § 303(d) Priority List and Report.

The impaired segments include: 36.7 miles of the South Fork Holston River from the headwaters downstream to the backwaters of South Holston; 0.48 miles of Bishop Branch from the confluence with the South Fork Holston River upstream to the confluence with Parker Branch; 4.00 miles of Grosses Creek from the headwaters downstream to the confluence with the South Fork Holston River; 3.85 miles of Slemp Creek from the headwaters downstream to the confluence with the South Fork Holston River.

The first public meeting on the development of the TMDL to address the bacteria impairments for these segments will be held on March 3, 2015, from 6 p.m. to 8 p.m. at the Chilhowie Town Hall, 325 East Lee Highway, Chilhowie, VA 24319. In the event of inclement weather, the meeting will be held at the same location on March 9, 2015, from 6 p.m. to 8 p.m.

The public comment period will begin on March 3, 2015, and end on April 3, 2015. An advisory committee to assist in development of this TMDL will be established. Persons interested in assisting should notify the DEQ contact person listed below by the end of the comment period and provide their name, address, phone number, email address, and the organization they represent (if any). Notification of the composition of the panel will be sent to all applicants.

A component of a TMDL is the wasteload allocations (WLAs); therefore, this notice is provided pursuant to § 2.2-4006 A 14 of the Administrative Process Act for any future adoption of the TMDLs associated WLAs. Information on the development of the TMDLs for these impairments is available upon request. Questions or information requests should be addressed to Martha Chapman, Department of Environmental Quality, Southwest Regional Office, 355-A Deadmore Street, Abingdon, VA 24210, telephone (276) 676-4800, or email martha.chapman@deq.virginia.gov.

Note, all written comments should include name, address, and telephone number of the person submitting the comments and should be sent to Martha Chapman, Department of Environmental Quality, Southwest Regional Office, 355-A Deadmore Street, Abingdon, VA 24210, telephone (276) 676-4800, or email martha.chapman@deq.virginia.gov.

VIRGINIA LOTTERY

Director's Orders

The following Director's Orders of the Virginia Lottery were filed with the Virginia Registrar of Regulations on February 3, 2015. The orders may be viewed at the Virginia Lottery, 900 East Main Street, Richmond, Virginia, or at the office of the Registrar of Regulations, 201 North 9th Street, 2nd Floor, Richmond, Virginia.

Director's Order Number One Hundred Eighty (14)

Virginia Lottery's Hit it Big Time! Promotion Final Rules for Operation (This Director's Order becomes effective on Tuesday, March 10, 2015, and shall remain in full force and effect unless amended or rescinded by further Director's Order)

Director's Order Number Three (15)

Certain Virginia Instant Game Lotteries; End of Games.

In accordance with the authority granted by §§ 2.2-4002 B 15 and 58.1-4006 A of the Code of Virginia, I hereby give notice that the following Virginia Lottery instant games will officially end at midnight on Friday, January 9, 2015:

The last day for lottery retailers to return for credit unsold tickets from any of these games will be Friday, February 27, 2015. The last day to redeem winning tickets for any of these games will be Wednesday, July 8, 2015, 180 days from the declared official end of the game. Claims for winning tickets from any of these games will not be accepted after that date. Claims that are mailed and received in an envelope bearing a postmark of the United States Postal Service or another sovereign nation of Wednesday, July 8, 2015, or earlier, will be deemed to have been received on time. This notice amplifies and conforms to the duly adopted State Lottery Board regulations for the conduct of lottery games.

This order is available for inspection and copying during normal business hours at the Virginia Lottery headquarters, 900 East Main Street, Richmond, Virginia, and at any Virginia Lottery regional office. A copy may be requested by mail by writing to Director's Office, Virginia Lottery, 900 East Main Street, Richmond, Virginia 23219.

This Director's Order becomes effective on the date of its signing and shall remain in full force and effect unless amended or rescinded by further Director's Order.

/s/ Paula I. Otto
Executive Director
January 7, 2015

Director's Order Number Four (15)

"7-Eleven® Scratcher Retailer Incentive Promotion" Virginia Lottery Retailer Incentive Program Requirements (This Director's Order becomes effective on March 10, 2015, and shall remain in full force and effect until ninety (90) days after the conclusion of the Incentive Program, unless otherwise extended by the Director)

Director's Order Number Five (15)

Virginia Lottery's "#PICKYOURDECADEPHOTOPROMOTION" Final Rules for Operation (effective January 22, 2015)

Director's Order Number Eight (15)

This order rescinds Director's Order Number One (15): "Pick Your Decade" Promotion Final Rules for Operation effective January 27, 2015

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Amendments to Enhance FAMIS MOMS

Virginia's Title XXI Child Health Insurance Plan (CHIP) covers children with family income from 143% to 200% of the federal poverty level (FPL) under a separate child health plan known as the Family Access to Medical Insurance Security Plan (FAMIS). Virginia's Title XXI Health Insurance Flexibility and Accountability (HIFA) Demonstration has two objectives. First, it expands Title XXI coverage to uninsured pregnant women with family income up to 200% FPL (with a 5.0% income disregard) who are not eligible for Medicaid, through a program known as FAMIS MOMS. Second, it uses Title XXI funds to support a health insurance premium assistance program known as FAMIS Select. Children must first be found eligible and enroll in FAMIS before electing coverage through FAMIS Select.

Targeting these two populations - uninsured pregnant women with family income up to 200% FPL (with a 5.0% income disregard) who are not eligible for Medicaid and FAMIS-eligible children with access to employer-sponsored or private health insurance - is expected to yield the following outcomes:

• A decrease in the rates of uninsurance among pregnant women,

• An increase in participation in premium assistance in CHIP,

• An increase in access to appropriate medical services, and

• An improvement in certain health outcomes of children.

Virginia's current HIFA Demonstration is approved through June 30, 2016. The Department of Medical Assistance Services (DMAS) proposes to make the following changes to the Demonstration:

• Expand eligibility to include pregnant women who have access to the state employee health plan and who are otherwise eligible for the FAMIS MOMS program, and

• Add dental services to the benefits available to FAMIS MOMS program enrollees.

No changes are proposed for the FAMIS Select program.

Background - FAMIS MOMS

The purpose of the FAMIS MOMS program is to provide prenatal care to uninsured women living within the Title XXI income range and likely to give birth to a FAMIS-eligible child. The FAMIS MOMS program provides eligible pregnant women the same comprehensive coverage that pregnant women receive from the Virginia Medicaid program. There is no difference in covered services, service limitations, or pre-authorization requirements. The cost sharing requirements for FAMIS MOMS are consistent with those described in the Medicaid State Plan for pregnant women. There are no premiums, enrollment fees, or co-payments for pregnancy-related services. However, consistent with Title XXI requirements, to be eligible for FAMIS MOMS a pregnant woman must be uninsured, not an inpatient in an institution for mental diseases, and under current policy, not a member of a family eligible for coverage under the state employee health insurance plan. Under the Demonstration, infants born to FAMIS children and FAMIS MOMS are deemed eligible for Medicaid or CHIP coverage, as appropriate, on the date of birth and remain eligible until age one year, unless, after a reasonable opportunity period, DMAS fails to obtain satisfactory documentation of citizenship and identity.

In 2012 health care coverage for pregnant women under FAMIS MOMS was extended to otherwise eligible lawfully residing immigrants, including those in their first five years of lawful residency in the United States, pursuant to § 214 of the Children's Health Insurance Program Reauthorization Act of 2009.

FAMIS MOMS uses the same health care service delivery systems (fee-for-service and managed care organizations) as FAMIS. All pregnant women are initially enrolled under fee-for-service. Approximately 90% of new enrollees are transferred to a managed care organization (MCO) within two months.

Proposal

In September 2014, Governor McAuliffe announced "A Healthy Virginia," his 10-point plan to improve access to health care services for residents of the Commonwealth. This plan includes initiatives to enhance access to health care coverage under FAMIS and FAMIS MOMS.

Access to coverage for dependents of state employees:

The Patient Protection and Affordable Care Act (2010) permits states to extend eligibility in the state's CHIP program (FAMIS) to children of state employees who are otherwise eligible under the state child health plan. At the Governor's direction, DMAS has taken necessary steps to implement this option. DMAS now proposes to extend this opportunity to pregnant women who may access coverage under the state employee health plan and are otherwise eligible for FAMIS MOMS, by amending the Demonstration project.

The FAMIS MOMS upper income limit is set at 200% FPL. For a parent with one child, an income of 200% FPL is $2,622 a month or $31,460 annually (gross income). The median state salary is $38,957 a year while the lowest state salary is $15,371. There are approximately 33,000 state employees with salaries between the lowest and median amounts. The average household size is two. Last year, more than 9,600 full-time state employees qualified for the Earned Income Tax Credit, a federal tax subsidy for lower-income working families.

State employees may cover their dependents through their employee health insurance, but for many families this is not an affordable option. Employees who choose this option face an increase in their insurance premium contributions of approximately $100 to $200 per month. Even with the most comprehensive coverage, employees must also pay co-pays of up to $40 for doctor visits. These out-of-pocket expenses represent a significant reduction in take home pay for many state workers. Some may be forced to opt for employee-only coverage, thereby leaving their dependent family members, including a wife who is or may become pregnant, with no health insurance; others may struggle to pay for rent or other necessities because of the additional cost for their health insurance. Low-income state workers who are pregnant face these same financial struggles and difficult choices about insurance coverage. Reduced access to covered medical services creates increased health risks for pregnant women and their unborn babies. Providing the option to enroll in FAMIS MOMS alleviates a potential barrier to accessing prenatal care and improves the likelihood of a positive birth outcome.

Dental care for pregnant women:

At the Governor's direction, Virginia's nationally recognized "Smiles For Children" program is expanding to provide dental benefits to pregnant women in Medicaid. DMAS now proposes to extend these benefits to pregnant women who are otherwise eligible for FAMIS MOMS by amending the Demonstration project.

Dental coverage for pregnant women enrolled in Medicaid or FAMIS MOMS will assist in improving the dental health of the mother, decrease dental emergencies, and improve the likelihood of delivery of a healthy baby by preventing the transmission of cavity-causing bacteria from mother to baby. DMAS is working with the dental benefits administrator, DentaQuest, to implement an oral health program for pregnant women enrolled in Medicaid and FAMIS MOMS. The services are inclusive of those provided in Virginia's "Smiles For Children" program and similar in scope to dental services available through the Department of Human Resource Management dental benefits for state employees. Services for pregnant women will include the following:

• Diagnostic (x-rays, exams);

• Preventive (cleanings);

• Restorative (fillings);

• Endodontics (root canals);

• Periodontics (gum related treatment);

• Prosthodontics - both removable and fixed (crowns, bridges, partials, and dentures);

• Oral surgery (extractions and other oral surgeries); and

• Adjunctive general services (all covered services that do not fall into specific dental categories).

Pregnant women enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older will be eligible to receive comprehensive benefits, excluding orthodontics, covered by the "Smiles For Children" program. These benefits will be discontinued at the end of the month following the 60th day postpartum.

Estimated Enrollment and Expenditures

Actions of the General Assembly in 2013 ended enrollment of new participants in FAMIS MOMS effective January 1, 2014. As a result, enrollment declined steadily over 2014 as women gave birth and their benefits ended. Overall in federal fiscal year (FFY) 2014, enrollment in FAMIS MOMS averaged 884 pregnant women monthly. The cost of health care benefits during this time period totaled $12,593,890. Administrative costs for both components of the Demonstration (FAMIS MOMS and FAMIS Select) totaled $294,705. The total cost of the Demonstration was $13,155,698 of which $8,551,204 was paid by the federal Title XXI fund and $4,604,494 paid by the state general fund.

Enrollment in FAMIS MOMS was reinstated on December 1, 2014. In the first two months, 247 women enrolled; fiscal forecasts are based on a monthly average of 776 during FFY 2015. Eligibility for FAMIS MOMS is highly dependent on family income. While data on the range and averages of state employee income are available, information on the total family income is not known. Therefore, DMAS does not have a reliable estimate of the number of pregnant women with options for coverage under the state health plan who may be eligible to enroll in FAMIS MOMS.

The projected expense for adding dental coverage for pregnant women in Medicaid and FAMIS MOMS to the DentaQuest contract has been calculated at $0.13 per member per month. Based on the average monthly enrollment of 776 pregnant women in FAMIS MOMS, this equates to a cost of $807 for the remainder of FFY 2015.

Hypothesis and Evaluation

DMAS expects that FAMIS MOMS will continue to be a viable option to obtain quality health care coverage for uninsured pregnant women with family income up to 200% of the federal poverty level who are not eligible for Medicaid. DMAS further expects that pregnant women participating in FAMIS MOMS will receive preventive and treatment dental services. DMAS will evaluate these hypotheses through analyses of enrollment and dental services utilization data.

Waiver and Expenditure Authority

Under the authority of § 1115(a)(2) of the Social Security Act, DMAS may extend health insurance coverage through the CHIP program for those uninsured pregnant women with incomes up to and including 200% of the federal poverty level, including lawfully residing pregnant women.

Under § 1115 (a) of the Social Security Act, infants born to FAMIS children or FAMIS MOMS are deemed eligible for Medicaid or CHIP coverage, as appropriate, on the date of birth, and remain eligible until attaining the age of one year, unless, after a reasonable opportunity period, DMAS fails to obtain satisfactory documentation of citizenship and identity.

The following Title XXI requirements are not applicable for the Virginia FAMIS MOMS and FAMIS Select § 1115 Demonstration:

1. General Requirements, Eligibility and Outreach, § 2102. The Commonwealth's Child Health Insurance Plan (CHIP) does not have to reflect the demonstration populations, and eligibility standards do not have to be limited by the general principles in § 3202(b) of the Social Security Act. To the extent other requirements in § 2102 of the Act duplicate Medicaid or other CHIP requirements for these or other populations, they do not apply, except that the state must perform eligibility screening to ensure that the demonstration populations do not include individuals otherwise eligible for Medicaid.

2. Cost Sharing, § 2103(e). Rules governing cost sharing under § 2103(e) of the Act shall not apply to the FAMIS Select population to the extent necessary to enable the state to impose cost sharing in private or employer-sponsored insurance plans.

3. Cost-Sharing Exemption for American Indian (AI) Children, § 2102(b)(3)(D) and Alaskan Native (AN) Children, 42 CFR Section 457.535. To the extent necessary to permit the Commonwealth to impose cost sharing on AI/AN children who elect to enroll in the premium assistance program.

4. Benefit Package Requirements, § 2103. To permit the Commonwealth to offer a benefit package that does not meet the requirements of § 2103 at 42 CFR section 457.4 10(b)(1) for the demonstration populations.

5. Federal Matching Payment and Family Coverage Limits, § 2105. Federal matching payment in excess of the 10% cap for expenditures related to the demonstration population and limits on family coverage are not applicable to the demonstration population.

Public Review and Comment

Copies of the Demonstration amendment are available for public review from the Department of Medical Assistance Services, Division of Maternal and Child Health, 600 East Broad Street, Richmond, VA 23219 and on the Department of Medical Assistance Services website at http://dmas.virginia.gov/ through a link in the "What's New" column. DMAS is seeking comments on the proposed amendment to the Demonstration. Anyone wishing to submit comments may do so to Joanne Boise by mail at Department of Medical Assistance Services, Division of Maternal and Child Health, 600 East Broad Street, Richmond, VA 23219, or email to joanne.boise@dmas.virginia.gov. In order to be considered, comments must be received by March 31, 2015. DMAS will convene two public hearings to seek public input on the Demonstration amendment. Both oral and written comments may be submitted at that time.

Public Hearing 1

When: February 12, 2015, 10 a.m.

Where: Virginia Department of Medical Assistance Services, 600 East Broad Street, Room 7 D, Richmond, VA 23219

Conference Call Option: 1-866-842-5779 (Passcode: 2761019567)

Public Hearing 2

When: March 5, 2015, 1 p.m.

Where: Quarterly Children's Health Insurance Advisory Committee Meeting, Virginia Community Healthcare Association, Westerre Conference Center, 3831 Westerre Parkway, Henrico, VA 23233

Contact Information: Joanne Boise, Senior Policy Analyst, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 225-2334, or email joanne.boise@dmas.virginia.gov.

STATE WATER CONTROL BOARD

Proposed Consent Special Order for Brook Hill Partners, LLC

An enforcement action has been proposed for Brook Hill Partners, LLC, for alleged violations that occurred at Village at the Arbors Apartments located at 5613 Crenshaw Road in Richmond, Virginia. The State Water Control Board proposes to issue a consent special order to Brook Hill Partners, LLC, to address noncompliance with State Water Control Law. A description of the proposed action is available at the Department of Environmental Quality office named below or online at www.deq.virginia.gov. Cynthia Akers will accept comments by email at cynthia.akers@deq.virginia.gov, FAX at (804) 527-5106, or postal mail at Department of Environmental Quality, Piedmont Regional Office, 4949-A Cox Road, Glen Allen, VA 23060, from February 23, 2015, through March 25, 2015.

Proposed Enforcement Action for CSX Transportation, Inc.

An enforcement action has been proposed for CSX Transportation, Inc., regarding a release of petroleum into the James River in Lynchburg, Virginia for violations of State Water Control Law and regulations. The proposed enforcement action includes a civil charge and injunctive relief. A description of the proposed action is available at the Department of Environmental Quality office named below or online at www.deq.virginia.gov. Robert Steele will accept comments by email at robert.steele@deq.virginia.gov, FAX at (540) 562-6725, or postal mail at Department of Environmental Quality, Roanoke Regional Office, 3019 Peters Creek Road, Roanoke, VA 24019, from February 23, 2015, through March 25, 2015.

Proposed Enforcement Action for Hampton Roads Transit

An enforcement action has been proposed for Hampton Roads Transit (HRT) for alleged violations of the State Water Control Law at the HRT bus garage in Norfolk, Virginia. A description of the proposed action is available at the Department of Environmental Quality office named below or online at www.deq.virginia.gov. Mr. Robin Schuhmann will accept comments by email at robin.schuhmann@deq.virginia.gov, FAX at (757) 518-2009, or postal mail at Department of Environmental Quality, Tidewater Regional Office, 5636 Southern Boulevard, Virginia Beach, VA 23462, from February 23, 2015, through March 25, 2015.

VIRGINIA CODE COMMISSION

Notice to State Agencies

Contact Information: Mailing Address: Virginia Code Commission, General Assembly Building, 201 North 9th Street, 2nd Floor, Richmond, VA 23219; Telephone: Voice (804) 786-3591; FAX (804) 692-0625; Email: varegs@dls.virginia.gov.

Meeting Notices: Section 2.2-3707 C of the Code of Virginia requires state agencies to post meeting notices on their websites and on the Commonwealth Calendar at http://www.virginia.gov/connect/commonwealth-calendar.

Cumulative Table of Virginia Administrative Code Sections Adopted, Amended, or Repealed: A table listing regulation sections that have been amended, added, or repealed in the Virginia Register of Regulations since the regulations were originally published or last supplemented in the print version of the Virginia Administrative Code is available at http://register.dls.virginia.gov/documents/cumultab.pdf.

Filing Material for Publication in the Virginia Register of Regulations: Agencies use the Regulation Information System (RIS) to file regulations and related items for publication in the Virginia Register of Regulations. The Registrar's office works closely with the Department of Planning and Budget (DPB) to coordinate the system with the Virginia Regulatory Town Hall. RIS and Town Hall complement and enhance one another by sharing pertinent regulatory information.

ERRATA

VIRGINIA WASTE MANAGEMENT BOARD

Title of Regulation: 9VAC20-60. Virginia Hazardous Waste Management Regulations.

Publication: 30:24 VA.R. 2627-2636 July 28, 2014.

Correction to Final Regulation:

Page 2635, column 1, 9VAC20-60-1285, the parenthetical at the beginning of the section is amended as follows: "(The effective date of this fee schedule is July 1, 2004 August 27, 2014.)"

VA.R. Doc. No. R14-4022; Filed February 5, 2015, 12:40 p.m.