DEPARTMENT OF ENVIRONMENTAL QUALITY
Proposed Enforcement Action for Greene County
The Virginia Department of Environmental Quality (DEQ) is proposing an enforcement action for Greene County for violations of the State Water Control Law and regulations at the Rapidan wastewater treatment plant in Greene County. The proposed order is available from the DEQ contact listed or at https://www.deq.virginia.gov/permits/public-notices/enforcement-orders. The DEQ contact will accept comments by email or postal mail from June 17, 2024, to July 17, 2024.
Contact Information: Jonathan Chapman, Enforcement Specialist, Southwest Regional Office, Department of Environmental Quality, 355-A Deadmore Street, Abingdon, VA 24210, or email jonathan.chapman@deq.virginia.gov.
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Opportunity for Review and Public Comment on Amendments to the State Plan Rate for Early and Periodic Screening, Diagnosis, and Treatment Therapeutic Group Homes
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 Rate; Other Types of Care (12VAC30-80).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
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 the contact listed and such comments are available for review at the same address. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
In accordance with Item 288 EEEEE of Chapter 2 of the 2024 Acts of Assembly, Special Session I, DMAS will be making the following change to Methods and Standards for Establishing Payment Rate; Other Types of Care (12VAC30-80):
The state plan is being revised to indicate that the rate for Early and Periodic Screening, Diagnosis, and Treatment therapeutic group homes, which serve individuals both a behavioral health diagnosis and a diagnosis of either intellectual or developmental disability, will be set as of July 1, 2024. The expected increase in annual fee-for-service aggregate expenditures is $153,161 in state general funds and $160,823 in federal funds in federal fiscal year 2024.
Contact Information: 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, TDD (800) 343-0634, or email emily.mcclellan@dmas.virginia.gov.
Opportunity for Review and Public Comment on Amendments to the State Plan to Implement Supplemental Disproportionate Share Hospital Redistribution Methodology
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 Hospital Care (12VAC30-70).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
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 the contact listed and such comments are available for review at the same address. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
In accordance with Item 288 MM of Chapter 2 of the 2024 Acts of Assembly, Special Session I, DMAS will be making the following change to Methods and Standards for Establishing Payment Rates; In-Patient Hospital Care (12VAC30-70):
The state plan is being revised to implement a supplemental disproportionate share hospital (DSH) redistribution methodology for DSH funds that allows the redistribution of excess DSH payments to other eligible DSH hospitals that have not met their uncompensated care costs. This supplemental redistribution shall be budget neutral and not use state funds in excess of those already appropriated for DSH payments. There is no expected increase or decrease in annual fee-for-service aggregate expenditures in federal fiscal year 2024 or 2025.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisor, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.
Opportunity for Review and Public Comment on Amendments to the State Plan to Revise Institutional Provider Reimbursement
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 Hospital Care (12VAC30-70).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
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 the contact listed and such comments are available for review at the same address. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
DMAS will be making the following changes to Methods and Standards for Establishing Payment Rates; In-Patient Hospital Care (12VAC30-70):
In accordance with Item 288 HH 5 of Chapter 2 of the 2024 Acts of Assembly, Special Session I, the state plan is being amended to revise reimbursement methodologies for psychiatric residential treatment facility (PRTF) rates to implement inflation increases for each fiscal year to be effective July 1, 2024. Inflation rates shall be tied to the Nursing Facility Moving Average as established by IHS Markit or its successor. The most recent four quarters will be averaged to create the PRTF inflation rate.
There is no expected increase or decrease in annual fee-for-service aggregate expenditures in federal fiscal year 2024 or 2025.
To correct language to be consistent with current DMAS policies and regulations, the state plan is being revised to remove two phrases that pertain to adjustment factors for Type Two hospitals that were not authorized by the Virginia General Assembly or approved by the Centers for Medicare and Medicaid Services for addition to the state plan. There are no costs associated with these changes because the phrases were unauthorized errors.
There is no expected increase or decrease in annual fee-for-service aggregate expenditures in federal fiscal year 2024 or 2025.
In accordance with Item 288 PP 2 of Chapter 2 of the 2024 Acts of Assembly, Special Session I, the state plan is being revised to make hospital supplemental payments for freestanding children's hospitals with greater than 50% Medicaid utilization in 2009 to replace payments that have been reduced due to the federal regulation on the definition of uncompensated care costs effective June 2, 2017, equal to the greater of what would have been paid to the freestanding children's hospitals under the current uncompensated care formula or $16 million annually, the average due by formula prior to Medicaid expansion without regard to the uncompensated care cost limit. The expected increase in annual aggregate fee-for-service expenditures is $1,960,400 in state general funds and $2,039,600 in federal funds in federal fiscal year 2024 and $7,841,600 in state general funds and $8,158,400 in federal funds in federal fiscal year 2025.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisor, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.
Opportunity for Review and Public Comment on Amendments to the State Plan to Update Noninstitutional Provider Reimbursement
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 Rate; Other Types of Care (12VAC30-80).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
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 the contact listed and such comments are available for review at the same address. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
In accordance with Item 288.BBBB.2 of Chapter 2 of the 2024 Acts of Assembly, Special Session I, DMAS will be making the following changes to Methods and Standards for Establishing Payment Rate; Other Types of Care (12VAC30-80). the state plan is being revised to increase reimbursement rates for dental services by 3.0%. The expected increase in annual fee-for-service aggregate expenditures is $664,129 in state general funds, $64,314 in special funds, and $1,276,171 in federal funds in federal fiscal year 2024; and $4,083,634 in state general funds, $393,599 in special funds, and $8,184,610 in federal funds in federal fiscal year 2025.
In accordance with Item 288 GGGGG1 of Chapter 2 of the 2024 Acts of Assembly, Special Session I, the state plan is being revised to increase the rates for agency-directed and consumer-directed personal care under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit by 2.0%. A corresponding rate increase of 2.0% will be provided for these services and for companion and respite services provided under home and community-based waivers; however, the increase is not included in a state plan amendment but via waiver documentation. The expected increase in annual fee-for-service aggregate expenditures is $104 in state general funds and $109 in federal funds in federal fiscal year 2024 and $625 in state general funds and $651 in federal funds in federal fiscal year 2025.
In accordance with Item 288 SSSS of Chapter 2 of the 2024 Acts of Assembly, Special Session I, the state plan is being revised to update the reimbursement methodology for outpatient rehabilitation services to the Resource Based Relative Value Scale. Any changes to the reimbursement methodology shall be budget neutral. To ensure and maintain budget neutrality, a budget neutrality factor shall be applied to any rate calculations. There is no expected increase or decrease in annual fee-for-service aggregate expenditures in federal fiscal year 2024 or 2025.
In accordance with Item 288 XXXX of Chapter 2 of the 2024 Acts of Assembly, Special Session I, the state plan is being revised to update the rates for consumer-directed facilitation services under EPSDT based on the most recent rebasing estimates as follows: Consumer-Directed (CD) Management Training shall be increased to $90.14 per hour in Northern Virginia and to $80.91 per hour in the rest of the state; CD Initial Comprehensive Visit shall be increased to $360.54 per visit in Northern Virginia and to $323.64 per visit in the rest of the state; CD Routine Visit shall be increased to $112.67 per visit in Northern Virginia and to $101.14 per visit in the rest of the state; and CD Reassessment Visit shall be increased to $180.27 per visit in Northern Virginia and to $161.82 per visit in the rest of the state. The expected increase in annual fee-for-service aggregate expenditures is $398 in state general funds and $418 in federal funds in federal fiscal year 2024 and $2,800 in state general funds and $2,913 in federal funds in federal fiscal year 2025.
In accordance with Item 288 YYYY of Chapter 2 of the 2024 Acts of Assembly, Special Session I, the state plan is being revised to set the reimbursement rate to 100% of the Medicare rural rates or 100% of nonrural rates if a rural rate does not exist for specific durable medical equipment products, including enteral products and supplies and in the following categories in the DMAS fee schedule: feeding kits and tubes and nutrition kits and feeding tubes. The expected increase in annual fee-for-service aggregate expenditures is $7,966 in state general funds, $136 in special funds, and $9,587 in federal funds in federal fiscal year 2024; and $48,024 in state general funds, $815 in special funds, and $58,114 in federal funds in federal fiscal year 2025.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisor, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.
Opportunity for Review and Public Comment on Amendments to the State Plan to Amend Nursing Facility Value-Based Purchasing Program
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 for Long-Term Care (12VAC30-90).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
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 the contact listed and such comments are available for review at the same address. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
DMAS will be making the following changes to Methods and Standards for Establishing Payment Rates for Long-Term Care (12VAC30-90):
In accordance with the General Assembly, DMAS revised the state plan in 2022 and 2023 to establish a unified, value-based purchasing (VBP) program that includes enhanced funding for nursing facilities that meet or exceed performance or improvement thresholds as developed, reported, and consistently measured by DMAS in cooperation with participating facilities. During the first year of the program, half of the available funding was distributed to participating nursing facilities to be invested in functions, staffing, and other efforts necessary to build their capacity to enhance the quality of care furnished to Medicaid members. This funding was administered as a Medicaid rate add-on. The remaining funding was allocated based on performance criteria as designated under the nursing facility VBP program. During the second year of the program, the amount of funding devoted to nursing facility quality of care investments was 25% of available funding.
In accordance with Item 288 QQQ 2 b of Chapter 2 of the 2024 Acts of Assembly, Special Session I, DMAS is amending the state plan for the third year of the nursing facility VBP program. During the third year of the program, 100% of payments will be disbursed to participating nursing facilities that qualify for the enhanced funding based on performance criteria. There is no expected increase or decrease in annual aggregate fee-for-service expenditures in federal fiscal year 2024. The expected increase in annual aggregate fee-for-service expenditures is $911,586 in state general funds and $948,414 in federal funds in federal fiscal year 2025.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisor, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.
Opportunity for Review and Public Comment on Amendments to the State Plan to Adjust Supplemental Payments for Acute Care Hospital Chain with Level One Trauma Center
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 Hospital Services (12VAC30-70-291).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
DMAS is specifically soliciting input from stakeholders, providers, and beneficiaries on the potential impacts of the proposed changes discussed in this notice. Comments or inquiries may be submitted in writing within 30 days of this notice publication to the contact listed and such comments are available for review upon request. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
In accordance with Item 288 OO10 of Chapter 2 of the 2024 Acts of Assembly, Special Session I, DMAS will be making the following changes to Methods and Standards for Establishing Payment Rates; In-Patient Hospital Services (12VAC30-70):
The state plan is being revised to make supplemental payments through an adjustment to the formula for indirect medical education reimbursement, using managed care discharge days, for an acute care hospital chain with a level one trauma center in the Tidewater Metropolitan Statistical Area in 2020, upon the execution of affiliation agreements with public entities that are capable of transferring funds to the department for purposes of covering the nonfederal share of the authorized payments. Such public entities would enter into an interagency agreement with DMAS for this purpose. Public entities are authorized to use general fund dollars to accomplish this transfer. The funds to be transferred must comply with 42 CFR 433.51 and 42 CFR 433.54. As part of the interagency agreements, the department shall require the public entities to attest to compliance with applicable Centers for Medicare and Medicaid Services (CMS) criteria. DMAS shall also require any private hospital and related health systems receiving payments under this item to attest to compliance with applicable CMS criteria. The expected increase in annual fee-for-service aggregate expenditures is $568,202 in state general funds and $591,157 in federal funds in federal fiscal year 2024 and $2,272,807 in state general funds and $2,364,628 in federal funds in federal fiscal year 2025.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisor, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.
Opportunity for Review and Public Comment on Amendments to the State Plan to Include Supplemental Payments to Private Hospitals for Physician Services
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 Rate; Other Types of Care (12VAC30-80).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
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 the contact listed and such comments are available for review at the same address. Comments may also be submitted at https://townhall.virginia.gov/L/generalnotice.cfm.
In accordance with the Item 288 OO 9 a, b, and c of Chapter 2 of the 2024 Acts of Assembly, Special Session I, DMAS will be making the following changes to Methods and Standards for Establishing Payment Rate; Other Types of Care (12VAC30-80):
The state plan is being revised to make supplemental payments to private hospitals and related health systems that intend to execute affiliation agreements with public entities that are capable of transferring funds to DMAS for purposes of covering the non-federal share of the authorized payments. Virginia community colleges, Virginia public institutions of higher education, local governments, and instrumentalities of local government are public entities that are authorized to transfer funds to the department for purposes of covering the non-federal share of the authorized payments. Such public entities would enter into an interagency agreement with the department for this purpose.
DMAS shall have the authority to make the supplemental payments to private hospitals for physician services effective July 1, 2024. No payment shall be made without approval from the Centers for Medicare and Medicaid Services (CMS) and an interagency agreement with a public entity capable of transferring the non-federal share of authorized payments to DMAS. The funds to be transferred must comply with 42 CFR 433.51 and 42 CFR 433.54. Such funds may not be paid from any private agreements with public entities that are in excess of fair market value or that alleviate preexisting financial burdens of such public entities. Public entities are authorized to use general fund dollars to accomplish this transfer. As part of the interagency agreements, DMAS shall require the public entities to attest to compliance with applicable CMS criteria. DMAS shall also require any private hospital and related health systems receiving payments under this section to attest to compliance with applicable CMS criteria. Within 30 days of notification by DMAS of any deferral or disallowance issued by CMS regarding the supplemental or managed care directed payment arrangement, the hospital provider will return the entire balance of the payment to DMAS. If the hospital does not return the entire balance of the payment to DMAS within the specified timeframe, a judgment rate of interest set forth in § 6.2-302 of the Code of Virginia will be applied to the entire balance, regardless of whatever portion has been repaid. In addition, the non-federal share of the agency's administrative costs directly related to administration of the programs authorized in this notice, including staff and contractors, shall be funded by participating public entities. These funds shall be deposited into a special fund created by the comptroller and used to support the administrative costs associated with managing this program. Any funds received for this purpose but unexpended at the end of the fiscal year shall remain in the fund for use in accordance with this provision.
The purposes to which the additional payments authorized shall be applied include (i) increasing and enhancing access to outpatient care for Medicaid recipients, (ii) stabilizing and supporting critical health care workforce needs, and (iii) advancing the DMAS health and quality improvement goals; these shall contain specific measurable outcomes that will be approved and monitored by the department quarterly. Payment shall be dependent on progress toward goal attainment on all three purposes. Participating organizations must submit quarterly updates and annual reports on programs to DMAS no later than October 1. The expected increase in annual aggregate fee-for-service expenditures is $1,207,429 in state general funds and $1,256,209 in federal fiscal year 2024. The expected increase in annual aggregate fee-for-service expenditures is $4,829,714 in state general funds and $5,024,835 in federal funds in federal fiscal year 2025.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisor, Division of Policy and Research, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.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