STATE BOARD OF HEALTH

Revision to Waterworks Operation Fees (12VAC5-600-50), Effective July 1, 2021 – June 30, 2022

Purpose of notice and background information: The Virginia Department of Health Office of Drinking Water (ODW) is providing notice to all community waterworks of the change in the fee for each service connection from $2.95 to $3.00 under Chapter 552 of the 2021 Acts of Assembly and 12VAC5-600-50.

12VAC5-600-50 A states that the fee for each fiscal year for community waterworks is the number of customer accounts multiplied by no more than $3.00 and that the annual waterworks operation fee shall not exceed $160,000. Item 304 B of Chapter 552 of the 2021 Acts of Assembly states that the "fee schedule for charges to community waterworks shall be adjusted to the level necessary to cover the cost of operating the Waterworks Technical Assistance Program, consistent with § 32.1-171.1, Code of Virginia, and shall not exceed $3.00 per connection to all community waterworks."

For the fiscal year beginning July 1, 2021, ODW will bill waterworks $3.00 per customer account or service connection. This represents an increase of $0.05 per customer account over the fee for the fiscal year that began on July 1, 2020.

The revised fees are exempt from the requirements of the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia). Item 304 B of Chapter 552 of the 2021 Acts of Assembly allows ODW to adjust the fee up to but not above $3.00 to cover the cost of operating the Waterworks Technical Assistance Program. ODW is not accepting public comment on the fee increase.

Contact Information: Joseph Hilbert, Deputy Commissioner, Government and Regulatory Affairs, Virginia Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7001, FAX (804) 864-7022.

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Contact Information for all Department of Medical Assistance Services General Notices: Emily McClellan, Regulatory Manager, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, FAX (804) 786-1680.

Review of Forms

The Department of Medical Assistance Services (DMAS) is making these forms available for review:

DSP and Supervisors Competencies Checklist (DMAS P241a)

Direct Support Professional Assurance (DMAS P242a)

Supervisor Assurance (DMAS P245a)

Draft Addiction and Recovery Treatment Services Provider Manual

The draft Addiction and Recovery Treatment Services (ARTS) Provider Manual Chapter IV is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment period until June 23, 2021.

Draft Addiction and Recovery Treatment Services Provider Manual Opioid Treatment Services Supplement

The draft Addiction and Recovery Treatment Services (ARTS) Opioid Treatment Services/Medication Assisted Treatment Supplement is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/.

Draft Durable Medical Equipment Provider Manual

The draft Durable Medical Equipment Manual Chapters IV and VI are now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ until June 23, 2021.

Draft Eligibility Manual with Updates Effective on July 1, 2021

Please see the full text of the draft Eligibility Manual at https://www.dmas.virginia.gov/media/3461/draft-tn-dmas-20-5-28-2021.pdf.

Draft Home Health Provider Manual

The draft Home Health Provider Manual Chapter IV is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment until June 25, 2021.

Draft Local Education Agency Provider Manual

The draft Local Education Agency Provider Manual Chapter V is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/.

Draft Local Education Agency Provider Manual

The draft Local Education Agency Provider Manual Chapter IV is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment until June 25, 2021.

Draft Pharmacy Provider Manual

The draft Pharmacy Provider Manual Appendix D is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment period until June 23, 2021.

Draft Physician-Practitioner Provider Manual

The draft Physician-Practitioner Provider Manual Chapters IV and V are now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment period until June 23, 2021.

Draft Provider Manual Chapter 1

The draft Provider Manual Chapter 1 is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment until June 23, 2021.

Draft Psychiatric Provider Manual

The draft Psychiatric Provider Manual Chapter IV is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment period until June 23, 2021.

Draft Telehealth Services Supplement Provider Manual

The draft Telehealth Services Supplement Provider Manual is now available on the Department of Medical Assistance Services website at https://www.dmas.virginia.gov/for-providers/general-information/medicaid-provider-manual-drafts/ for public comment until June 23, 2021.

Intent to Amend the Virginia State Plan for Medical Assistance Pursuant to § 1902(a)(13) of the Social Security Act (USC § 1396a(a)(13)) -
Non-Institutional Provider Reimbursement Changes

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates; Other Types of Care (12VAC30-80).

This notice is intended to satisfy the requirements of 42 CFR 447.205 and § 1902(a)(13) of the Social Security Act (42 USC § 1396a(a)(13)). A copy of this notice is available for public review from Emily McClellan, see Contact Information at the beginning of the Department of Medical Assistance Services general notices.

DMAS is specifically soliciting input from stakeholders, providers, and beneficiaries on the potential impact of the proposed changes discussed in this notice. Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Emily McClellan and such comments are available for review at the same address. Comments may also be submitted, in writing, on the Virginia Regulatory Town Hall public comment forum at https://townhall.virginia.gov/L/generalnotice.cfm.

In accordance with Items 313 EEEE, UUUU, and VVVV of the 2021 Appropriations Act, DMAS will be making the following changes regarding

Methods and Standards for Establishing Payment Rates; Other Types of Care (12VAC30-80):

1. The state plan is being revised to increase rates for psychiatric services by 14.7% to the equivalent of 110% of Medicare rates, effective July 1, 2021.

The expected increase in annual aggregate expenditures is $593,674 in state general funds, $46,102 in special funds, and $1,046,444 in federal funds in federal fiscal year 2021.

2. The state plan is being revised to increase rates for anesthesiologists to reflect the equivalent of 70% of the 2019 Medicare rates.

The expected increase in annual aggregate expenditures is $65,623 in state general funds, $189,985 in federal funds, and $13,379 in special funds in federal fiscal year 2021.

3. The state plan is being revised to increase the supplemental physician payments for physicians employed at a freestanding children's hospital serving children in Planning District 8 to the maximum allowed by the Centers for Medicare and Medicaid Services within the limit of the appropriation provided for this purpose. The total supplemental Medicaid payment shall be based on the Upper Payment Limit approved by the Centers for Medicare and Medicaid Services and all other Virginia Medicaid fee-for-service payments.

The expected increase in annual aggregate expenditures is $88,692 in state general funds and $88,692 in federal funds in federal fiscal year 2021.

Intent to Amend the Virginia State Plan for Medical Assistance Pursuant to § 1902(a)(13) of the Social Security Act (USC § 1396a(a)(13)) -
2021 Institutional Provider Reimbursement Changes

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates; In-Patient Care (12VAC30-70) and Methods and Standards for Establishing Payment Rates for Long-Term Care (12VAC30-90).

This notice is intended to satisfy the requirements of 42 CFR 447.205 and § 1902(a)(13) of the Social Security Act (42 USC § 1396a(a)(13)). A copy of this notice is available for public review from Emily McClellan; see Contact Information at the beginning of the Department of Medical Assistance Services general notices.

DMAS is specifically soliciting input from stakeholders, providers, and beneficiaries, on the potential impact of the proposed changes discussed in this notice. Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Emily McClellan and such comments are available for review at the same address. Comments may also be submitted, in writing, on the Virginia Regulatory Town Hall at https://townhall.virginia.gov/L/generalnotice.cfm.

Methods and Standards for Establishing Payment Rates; In-Patient Care (12VAC30-70)

1. In accordance with Item 313 CC of the 2021 Special Session, the state plan is being revised to change per diem rates paid to Virginia-based psychiatric residential treatment facilities using the provider's audited cost per day from the facility's cost report for provider fiscal years ending in state fiscal year 2018. New Virginia-based residential psychiatric facilities must submit pro forma cost report data, which will be used to set the initial per diem rate for up to two years. After this period, the department shall establish a per diem rate based on an audited cost report for a 12-month period within the first two years of operation. Virginia-based residential psychiatric facilities that do not submit cost reports shall be paid at 75% of the established rate ceiling. If necessary to enroll out-of-state providers for network adequacy, the department shall negotiate rates. If there is sufficient utilization DMAS may require out-of-state providers to submit a cost report to establish a per diem rate. In-state and out-of-state provider per diem rates shall be subject to a ceiling based on the statewide weighted average cost per day from fiscal year 2018 cost reports.

The expected increase in annual aggregate expenditures is $1,899,924 in state general funds and $1,899,924 in federal funds in federal fiscal year 2021.

2. In accordance with Items 313 UU(9) of the 2021 Special Session, the state plan is being revised to implement a supplemental inpatient payment for Lake Taylor Transitional Care Hospital based on the difference between Medicaid reimbursement and the inpatient Upper Payment Limit for non-state-government owned hospitals. DMAS shall include in its contracts with managed care organizations a percentage increase for Lake Taylor Transitional Care Hospital consistent with the fee for service supplemental payment percentage increase and shall adjust capitation payments to Medicaid managed care organizations to fund this percentage increase. The originating funding for this program will come entirely from Lake Taylor for Lake Taylor.

The expected increase in annual aggregate expenditures is $1,359,319 in state general funds and $1,359,319 in federal funds in federal fiscal year 2021.

3. In accordance with Items 313 BBB of the 2021 Special Session, the state plan is being revised to clarify that supplemental payments for graduate medical education residency slots shall be in amounts of $100,000 minus any Medicare residency payment for which the sponsoring institution is eligible. For any residency program at a facility whose Medicaid payments are capped by the Centers for Medicare and Medicaid Services, the supplemental payments for each qualifying residency slot shall be $50,000 from the general fund annually minus any Medicare residency payments for which the residency program is eligible.

There is no expected increase or decrease in annual aggregate expenditures as a result of this clarification.

4. In accordance with Items 313 IIIIII(1) of the 2021 Special Session, the state plan is being revised to adjust the formula for indirect medical education (IME) reimbursement for managed care discharges for freestanding children's hospitals with greater than 50% Medicaid utilization in 2009 by increasing the case mix adjustment factor to 2.718. This increased case mix index (CMI) factor shall take precedence over future rebasing. Total payments for IME in combination with other payments for freestanding children's hospitals with greater than 50% Medicaid utilization in 2009 may not exceed the federal uncompensated care cost limit that disproportionate share hospital payments are subject to.

The expected increase in annual aggregate expenditures is $562,500 in state general funds and $562,500 in federal funds in federal fiscal year 2021.

Methods and Standards for Establishing Payment Rates for Long-Term Care (12VAC30-90)

1. In accordance with Items 313 GGGG of the 2021 Special Session, the state plan is being revised to modify reimbursement for nursing facility services such that the direct peer group price percentage shall be increased to 109.3% and the indirect peer group price percentage shall be increased to 103.3%.

The expected increase in annual aggregate expenditures is $1,746,197 in state general funds and $1,746,197 in federal funds in federal fiscal year 2021.

2. In accordance with Item 313 JJJJ of the 2021 Special Session, the state plan is being revised to provide that any nursing facility which thereafter loses its Medicaid capital reimbursement status as a hospital-based nursing facility because a replacement hospital was built at a different location and Medicare rules no longer allow the nursing home's cost to be included on the hospital's Medicare cost report shall have its first fair rental value (FRV) capital payment rate set at the maximum FRV rental rate for a new free-standing nursing facility with the date of acquisition for its capital assets being the date the replacement hospital is licensed.

The expected increase in annual aggregate expenditures is $29,989 in state general funds and $29,989 in federal funds in federal fiscal year 2021.

3. In accordance with Item 313 KKKK of the 2021 Special Session, the state plan is being revised to increase the direct and indirect operating rates from 15% to 25.4% above a facility's calculated price-based rates where at least 80% of the resident population have one or more of the following diagnoses: quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy. In addition, a qualifying facility must have at least 90% Medicaid utilization and a case mix index of 1.15 or higher in fiscal year 2014.

The expected increase in annual aggregate expenditures is $126,726 in state general funds and $126,726 in federal funds in federal fiscal year 2021.

4. In accordance with Item 313 LLLLL(1) of the 2021 Special Session, the state plan is being revised to increase nursing home and specialized care per diem rates by $15 per day effective July 1, 2021. Such adjustment shall be made through existing managed care capitation rates as a mandated specified rate increase. DMAS shall adjust capitation rates to account for the nursing facility rate increase. The specified rate increase in this paragraph applies across fee-for-service and Medicaid managed care.

The expected increase in annual aggregate expenditures is $11,680,754 in state general funds and $11,680,754 in federal funds in federal fiscal year 2021.

5. In accordance with, Item 313 RRRRR the 2021 Special Session, the state plan is being revised to implement a supplemental Medicaid payment for Department of Veterans Services (DVS) state government-owned nursing facilities. The total supplemental Medicaid payment for DVS state government owned nursing homes shall be based on the difference between the Upper Payment Limit of 42 CFR 447.272, as approved by the Centers for Medicare and Medicaid Services (CMS), and all other Medicaid payments subject to such limit made to such nursing homes.

The expected increase in annual aggregate expenditures is $762,714 in federal funds, $576,048 in general funds, and $2,620 in special funds in federal fiscal year 2021.

6. In accordance with Item 313 GGGGGG the 2021 Special Session, the state plan is being revised to defer the next scheduled nursing facility rate rebasing for one year in order to utilize the calendar year 2021 cost reports as the base year. The deferred year's rates would reflect the prior year rates inflated according to the existing reimbursement regulations.

There is no expected increase or decrease in annual aggregate expenditures as a result of this change.

STATE WATER CONTROL BOARD

Public Meeting and Notice of Public Comment for a Water Quality Study (Total Maximum Daily Load Study) for Lynch Creek and Reed Creek in Pittsylvania and Campbell Counties

Purpose of notice: The Department of Environmental Quality (DEQ) and its contractors, 3E and JMU, will discuss the process and data used to develop a water quality study known as a total maximum daily load (TMDL) for Lynch Creek and Reed Creek in Pittsylvania and Campbell Counties. These streams are listed on the § 303(d) TMDL Priority List and Report as impaired due to violations of Virginia's water quality standards for the General Standard (Benthics). Section 303(d) of the Clean Water Act and § 62.1-44.19:7 C of the Code of Virginia require DEQ to develop TMDLs for pollutants responsible for each impaired water contained in Virginia's § 303(d) TMDL Priority List and Report. The draft TMDL report will be presented at this meeting to provide an opportunity for local residents to learn about the condition of these streams, share information about the area, and become involved in the process of local water quality improvement. A public comment period from June 29, 2021, to July 28, 2021, will follow the meetings.

Description: In Pittsylvania and Campbell Counties, the entirety of Lynch Creek and Reed Creek are impaired for the "General Use" water quality standard, meaning the macroinvertebrates or "water bugs" are not healthy and diverse and subsequently do not meet the "aquatic life" water quality standard. DEQ and its contractors have worked to identify the pollutant cause for the benthic impairment through a weight of evidence approach. After the pollutant was identified, a water quality report was developed to describe the sources of the pollutant and recommend reductions to meet water quality goals or TMDLs for the impaired waters. A TMDL is the total amount of a pollutant a water body can contain and still meet water quality standards. To restore water quality, the pollutant levels need to be reduced to the TMDL amount.

The Virginia Department of Environmental Quality will virtually host the final public meeting for the Lynch Creek and Reed Creek total maximum daily load (TMDL) Project on Tuesday, June 29, 2021, from 6 p.m. to 8 p.m. at the following webinar link: https://attendee.gotowebinar.com/register/4723207698849803021. Please register ahead of the meeting. Given the current State of Emergency related to the COVID-19 pandemic, this meeting will be held entirely virtually. A computer or a telephone are necessary to participate virtually. All participants are encouraged to access the meeting using a computer to view presentations or visual displays, although audio only participation using a phone is also an option.

This meeting will be open to the public and all are welcome. A 30-day public comment period will follow this meeting, from June 29, 2021, through July 28, 2021. The goal of this meeting is to present a draft water quality improvement report for Lynch Creek and Reed Creek, which (i) describes the water quality improvement process in Virginia, known as the TMDL Process; (ii) provides information on biological monitoring efforts; and (iii) outlines reductions in sediment that are necessary to improve the aquatic life. During the TMDL development process, a technical advisory committee was formed, which consisted of representatives from state and local governments, Virginia Pollutant Discharge Elimination System permittees, landowners, and recreational and conservation groups in the watershed.

For assistance with technical issues when registering for either meeting or difficultly during the meeting, contact Rob Breeding at telephone (804) 698-4013 or robert.breeding@deq.virginia.gov. For more information, please contact Lucy Smith at lucy.smith@deq.virginia.gov or telephone (540) 562-6718.

In the event the Governor's State of Emergency is lifted, the meeting will be held on the same date and time at the Department of Environmental Quality, Blue Ridge Regional Office, Training Room, 901 Russell Drive, Salem, VA 24153. However, the virtual meeting option will still be available.

Public comment period: June 29, 2021, through July 28, 2021.

How to submit comment: The meetings of the TMDL process are open to the public and all interested parties are welcome. Written comments will be accepted through July 28, 2021, and should include the name, address, and telephone number of the person submitting the comments. For more information or to submit comments, please contact Lucy Smith, Department of Environmental Quality, Blue Ridge Regional Office, telephone (540) 562-6718, email lucy.smith@deq.virginia.gov. For technical issues registering for either meeting or difficultly signing on to the meeting, contact Rob Breeding at telephone (804) 698-4013 or email robert.breeding@deq.virginia.gov.

Additional information: The draft TMDL report will be available prior to the meeting date at https://www.deq.virginia.gov/water/water-quality/tmdl-development/tmdls-under-development.

Proposed Enforcement Action for City of Alexandria, Virginia, Sanitation Authority

An enforcement action has been proposed for the City of Alexandria, Virginia, Sanitation Authority for violations of the State Water Control Law and regulations associated with the Alexandria Renew Enterprises water resources recovery facility, 1500 Eisenhower Avenue, Alexandria, Virginia. The State Water Control Board proposes to issue a consent order to resolve violations associated with the Alexandria Renew Enterprises water resources recovery facility. A description of the proposed action is available at the Department of Environmental Quality office listed or online at www.deq.virginia.gov/permits-regulations/public-notices. The staff contact person will accept comments by email or postal mail from June 22, 2021, through July, 22, 2021.

Contact Information: Stephanie Bellotti, Department of Environmental Quality, Northern Regional Office, 13901 Crown Court, Woodbridge, VA 22193, or email stephanie.bellotti@deq.virginia.gov.

Proposed Enforcement Action for the Town of Rural Retreat

An enforcement action has been proposed for the Town of Rural Retreat for violations of the State Water Control Law at the Rural Retreat wastewater treatment plant in Wythe County. A description of the proposed action is available at the Department of Environmental Quality office listed or online at www.deq.virginia.gov. The staff contact person will accept comments by email or postal mail from June 22, 2021, through July 22, 2021.

Contact Information: Jonathan Chapman, Department of Environmental Quality, Southwest Regional Office, 355-A Deadmore Street, Abingdon, VA 24210, or email jonathan.chapman@deq.virginia.gov.

VIRGINIA CODE COMMISSION

Notice to State Agencies

Contact Information: Mailing Address: Virginia Code Commission, Pocahontas Building, 900 East Main Street, 8th Floor, Richmond, VA 23219; Telephone: (804) 698-1810; 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 https://commonwealthcalendar.virginia.gov.

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.