DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES

2026 Annual Report on the Agricultural Stewardship Act Available for Review

The Commissioner of Agriculture and Consumer Services announces the availability of the annual report on the Agricultural Stewardship Act for the program year April 1, 2025, through March 31, 2026. Copies of the report are available without charge. A copy of the report can be obtained by submitting a request to the Department of Agriculture and Consumer Services (VDACS) contact listed. The report is also available on the VDACS website at http://www.vdacs.virginia.gov/conservation-and-environmental-agricultural-stewardship.shtml.

Contact Information: Darrell Marshall, Agricultural Stewardship Program Manager, Department of Agriculture and Consumer Services, P.O. Box 1163, Richmond, VA 23218, telephone (804) 786-2658, or email darrell.marshall@vdacs.virginia.gov.

STATE BOARD OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

Opportunity for Public Comment on Draft Amendments to the Certified Recovery Residences Regulations

The Department of Behavioral Health and Developmental Services (DBHDS) is seeking informal public comment on draft amendments to the Certified Recovery Residences Regulations (12VAC35-260).

The DBHDS Office of Regulatory Affairs, in collaboration with the Office of Addiction, Recovery, and Wellness Supports, developed the preliminary text pursuant Chapters 1000 and 1079 of the 2026 Acts of Assembly, which direct the Board of Behavioral Health and Developmental Services to promulgate regulations establishing minimum certification standards for recovery residences. Public comment on these initial draft amendments will help inform the board's standard three-stage regulatory action to be initiated in 2026-2027.

Public Comment Deadline: September 25, 2026.

The draft amendments are available at https://dbhds.virginia.gov/wp-content/uploads/2026/08/Recovery-Residence-Workgroup-draft.pdf.

Contact Information: Susan Puglisi, Regulatory Research Specialist, Department of Behavioral Health and Developmental Services, Jefferson Building, 1220 Bank Street, Fourth Floor, Richmond, VA 23219, fax (804) 371-6638, TDD (804) 371-8977, or email susan.puglisi@dbhds.virginia.gov.

DEPARTMENT OF ENVIRONMENTAL QUALITY

Proposed Enforcement Action for Bedford Regional Water Authority

The Virginia Department of Environmental Quality (DEQ) is proposing an enforcement action for Bedford Regional Water Authority for violations of State Water Control Law, regulations, and applicable permit at the Moneta Regional wastewater treatment plant located in Bedford, Virginia. The proposed order is available from the DEQ contact or at https://www.deq.virginia.gov/news-info/shortcuts/public-notices/enforcement-actions. The DEQ contact will accept written comments from September 21, 2026, to October 21, 2026.

Contact Information: Joseph Heller, Enforcement Specialist, Department of Environmental Quality, Blue Ridge Regional Office, 904 Russell Drive, Salem, VA 24153, or email joseph.r.heller@deq.virginia.gov.

Proposed Enforcement Action for Motorplex Inc.

The Virginia Department of Environmental Quality (DEQ) is proposing an enforcement action for Motorplex Inc. for violations of State Water Control Law, regulations, and applicable permit at the unpermitted land disturbance at parcels 34378, 34379, and 34380 Commerce Lane located in South Boston, Virginia. The proposed order is available from the DEQ contact or at https://www.deq.virginia.gov/news-info/shortcuts/public-notices/enforcement-actions. The DEQ contact will accept written comments from September 21, 2026, to October 21, 2026.

Contact Information: Megan Wisdom, Enforcement Specialist, Department of Environmental Quality, Piedmont Regional Office, 4949 Cox Road, Suite A, Glen Allen, VA 23060, or email megan.wisdom@deq.virginia.gov.

Proposed Enforcement Action for the Town of Glasgow

The Virginia Department of Environmental Quality (DEQ) is proposing an enforcement action for the Town of Glasgow for violations of State Water Control Law, regulations, and applicable permit at the Town of Glasgow wastewater treatment plan located in Glasgow, Virginia. The proposed order is available from the DEQ contact or at https://www.deq.virginia.gov/news-info/shortcuts/public-notices/enforcement-actions. The DEQ contact will accept written comments from September 21, 2026, to October 21, 2026.

Contact Information: Francesca Wright, Enforcement Specialist, Department of Environmental Quality, Valley Regional Office, 4411 Early Road, Harrisonburg, VA 22801, or email francesca.wright@deq.virginia.gov.

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Applied Behavior Analysis Workgroup Public Meetings

The Department of Medical Assistance Services (DMAS) is hosting a workgroup as directed by the General Assembly regarding the utilization of applied behavior analysis (ABA).

In this six-meeting series, the first workgroup meeting will take place on September 22, 2026, from 1 p.m. to 3:00 p.m.

Agenda items include: background of Virginia Medicaid's ABA benefit; purpose of the workgroup; statewide data on utilization trends; managed care organization (MCO) data on utilization trends, including by delivery method; and high level overview of clinical best practice guidelines.

Meeting details:

Microsoft Teams meeting

Join: https://teams.microsoft.com/meet/221475508908737?p=pkjoMTLtUmYQX28mkY

Meeting ID: 221 475 508 908 737

Passcode: Mq6xD7ed

Budget Item 291 13 C:

"3. The Department of Medical Assistance Services (DMAS) shall convene an ABA benefit Utilization Workgroup for the purpose of examining Medicaid expenditures and utilization trends for this service and identifying strategies to control costs while still preserving access to care for those in need of the therapy. The workgroup shall: (i) identify utilization trends, including trends among those with different diagnosis acuity levels; (ii) examine different delivery methods of ABA services and their impact on utilization; (iii) review utilization and service authorization criteria including standard assessment tools and diagnostic criteria taking into account differing service intensity and duration requirements; (iv) evaluate utilization management tools that align with national clinic practice guidelines promulgated by independent national nonprofit organizations; (v) define medical necessity criteria taking into account behavioral factors, ability to learn, age and development, and skills development including clear criteria for eligibility, scope of services and documentation requirements; (vi) review provider qualification recommendations related to ABA practitioner certification and licensing; and current supervision requirements and standards to help ensure appropriate clinical oversight; (vii) evaluate the appropriateness of ABA services for children with diagnoses other than ASD; and (viii) review the MCO annual reporting data to identify any areas of potential improvement to the delivery of services and any needed changes in regulations or policies from DMAS. The workgroup shall include stakeholders, including ABA service providers, including center-based models and home-based models, representatives from managed care organizations serving Medicaid patients, Virginia licensed behavioral analysts, and a child or adolescent psychiatrist. The workgroup meetings shall be open to the public and offer opportunities for public input."

Contact Information: Shamika Ward, Behavioral Health Program Specialist, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 773-1187, or email shamika.ward@dmas.virginia.gov.

Opportunity for Public Review of Community Psychiatric Support and Treatment - Youth, School Setting

The Virginia Department of Medical Assistance Services (DMAS) is seeking public comment on a new behavioral health service, Community Psychiatric Support and Treatment (CPST) - Youth, School Setting.

DMAS appreciates the comments received during previous public comment periods and is providing a revised draft CPST - Youth, School Setting service description available at https://dmas.virginia.gov/media/5ngi2vod/dmas-community-psychiatric-support-and-treatment-draft-school-setting-policy-08312026v2.pdf.

A summary of changes made to the previous draft is located at https://www.dmas-devbo.dmas.virginia.gov/media/0vkijs5c/dmas-community-psychiatric-support-and-treatment-school-setting-policy-change-summary-08-31-2026.pdf.

Additional information on Medicaid Behavioral Health Services Redesign is available on the DMAS website at https://www.dmas-devbo.dmas.virginia.gov/media/0vkijs5c/ dmas-community-psychiatric-support-and-treatment-school-setting-policy-change-summary-08-31-2026.pdf.

Contact Information: Syreeta Stewart, Regulatory Coordinator, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 298-3863, fax (804) 786-1680, TDD (800) 343-0634, or email syreeta.stewart@dmas.virginia.gov.

Opportunity for Public Review of and Comment on Intent to Amend State Plan - Cell and Gene Therapy Model - Unbundle Diagnosis Related Group

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) and 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 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 DMAS 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. Comments or inquiries may be submitted in writing until September 24, 2026, to the DMAS contact, 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 Hospital Care (12VAC30-70) and Methods and Standards for Establishing Payment Rates; Other Types of Care (12VAC30-80).

In accordance with Item 291 WWWWW 1 and 2 of the 2026 Appropriation Act, the State Plan will be revised to allow DMAS to participate in the Centers for Medicare and Medicaid Services (CMS) Cell and Gene Therapy Access Model, which is a partnership between CMS and states to provide sickle cell treatments for Medicaid members. A previous State Plan amendment (SPA) was filed with CMS to provide authority for value-based payment arrangements that are part of the model. This SPA reimburses hospitals for selected carved-out drugs separately from the inpatient All Patient Refined Diagnosis Related Group (APR-DRG) payment for drugs approved under the model. A separate outpatient claim will be submitted by the hospital for the reimbursement of these drugs at the acquisition cost.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures as a result of these changes.

Contact Information: Meredith Lee, Policy Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 371-0552, fax (804) 768-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.

Opportunity for Public Review of and Comment on Intent to Amend State Plan - Changes to Supplemental Payments, Graduate Medical Education Residencies, and Rural Hospitals

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) and 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 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 DMAS 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 until September 26, 2026, to the DMAS contact, 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 the 2025 Appropriations Act, DMAS will be making the following changes:

Methods and Standards for Establishing Payment Rates; In-Patient Hospital Care (12VAC30-70) and Methods and Standards for Establishing Payment Rates; Other Types of Care (12VAC30-80)

Item 291 LL 2: The state plan is being revised to modify supplemental payments for freestanding children's hospitals to equal the greater of what would have been paid to the freestanding children's hospitals under the current disproportionate share hospital (DSH) formula or annually the DSH formula effective in fiscal year 2026. These additional hospital supplemental payments shall take precedence over supplemental payments for private hospitals.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2027 or federal fiscal year 2028.

Item 291 QQ 2: The state plan is being revised to make supplemental payments for each new qualifying residency slot $145,000 annually minus any Medicare residency payment for which the sponsoring institution is eligible. For any residency program at a facility whose number of residency slots are above the cap set by the Centers for Medicare and Medicaid Services (CMS) or have exceeded the upper payment limit set by CMS, the supplemental payments for each qualifying residency slot shall be $72,500 from the general fund annually.

The expected increase in annual fee-for-service aggregate expenditures is $2,698,920 in state general funds and $2,701,080 in federal funds in federal fiscal year 2027, and $2,698,920 in state general funds and $2,701,080 in federal funds in federal fiscal year 2028.

Item 3-5 14 J: The state plan is being revised to require rural hospitals receiving enhanced payments to retain labor and delivery units. DMAS shall not provide private enhanced payments in the form of state directed payments to any rural hospital that does not currently operate a labor and delivery unit but such unit was operational in the rural hospital on January 1, 2026. For the purposes of this item, "rural hospital" means the same as defined CMS.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year 2027 or federal fiscal year 2028.

Contact Information: Meredith Lee, Policy Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 371-0552, fax (804) 768-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.

Opportunity for Public Review of and Comment on Intent to Amend State Plan - Indirect Medical Education

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 DMAS 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 until September 25, 2026, to the DMAS contact, 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.

In accordance with the 2026 Appropriations Act, DMAS will be making the following changes:

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

Item 291 JJ 10: The state plan is being revised to make supplemental payments through an adjustment to the formula for indirect medical education (IME) reimbursement, using managed care discharge days, for an acute care hospital system whose Virginia hospitals are located entirely in Planning Districts 1, 2, or 3, upon the execution of 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.

The expected increase in annual fee-for-service aggregate expenditures is $28,492,410 in federal funds in federal fiscal year (FFY) 2027 and in FFY 2028. The expected non-federal share will be $7,733,548 in FFY 2027 and in FFY 2028.

Item 291 JJ 11 a-b: The state plan is being revised to make supplemental IME payments for managed care services for private teaching hospitals that have executed 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.

The supplemental IME payments for managed care services shall be based on the Medicare formula using total residents reported to DMAS annually by the hospital prior to the beginning of the fiscal year for the resident-to-bed ratio applied to managed care hospital payments reported to DMAS through the encounter system adjusted to cost minus IME payments for managed care services currently authorized. DMAS shall calculate these supplemental IME payments prior to the beginning of the fiscal year based on the most recently available data and these payments shall be final.

The expected increase in annual fee-for-service aggregate expenditures is $15,733,656 in federal funds in FFY 2027 and in FFY 2028. The expected non-federal share will be $6,880,560 in FFY 2027 and in FFY 2028.

Item 291 JJ 14: The State Plan is being revised to make supplemental payments through an adjustment to the formula for IME reimbursement, using managed care discharge days, for an acute care hospital chain with a level two trauma center in the Peninsula Emergency Medical Services Region in 2023, upon the execution of 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. The level of these additional IME supplemental payments may be up to the amounts supported by the formula applicable to Type One hospitals.

Item 291 JJ 14: The expected increase in annual fee-for-service aggregate expenditures is $29,754,471 in federal funds in FFY 2027 and in FFY 2028. The expected non-federal share will be $10,118,719 in FFY 2027 and in FFY 2028.

Public entities that are capable of transferring funds to DMAS for purposes of covering the non-federal share of the authorized payments related to Item 291 JJ 10, Item 291 JJ 11 a-b, or Item 291 JJ 14 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, DMAS 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 to attest to compliance with applicable CMS criteria. In addition, the non-federal share of the agency's administrative costs directly related to administration of the programs, including staff and contractors, shall be funded by participating public entities.

Item 291 JJ 12: The State Plan is being revised to add qualified charitable contributions as a source for the non-federal share of Virginia Tech Carilion School of Medicine enhanced IMEreimbursement.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in FFY 2027 or in FFY 2028.

Contact Information: Meredith Lee, Policy Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 371-0552, fax (804) 768-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.

Opportunity for Public Review of and Comment on Intent to Amend State Plan - Nursing Facility 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 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 DMAS 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. Comments or inquiries may be submitted in writing until September 25, 2026, to the DMAS contact, 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.

In accordance with the 2026 Appropriation Act, DMAS will be making the following changes:

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

In accordance with Item 291BBB, the State Plan is being revised to provide direct and indirect operating rates equal to 25.4% above the calculated price-based rates for qualifying facilities 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, with at least 90% Medicaid utilization and a case-mix index of 1.15 or higher in fiscal year 2014. This continues reimbursement authorized in Item 306, CCC 7 of Chapter 780 of the 2016 Acts of Assembly, and Item 313, KKKK of Chapter 56 of the 2020 Acts of Assembly, Special Session I.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures in federal fiscal year (FFY) 2027 or FFY 2028.

In accordance with Item 291 LLL 1 b, the State Plan is being revised to increase nursing home and specialized care per diem rates effective until June 30, 2027. DMAS shall distribute the funding as an add-on payment to the per diem rates in effect as of June 30, 2026. This add-on payment shall be effective until June 30, 2027.

The expected increase in annual fee-for-service aggregate expenditures is $4,730,124 in state general funds and $5,069,876 in federal funds in FFY 2027, and there are no expected increases or decreases in annual fee-for-service aggregate expenditures in FFY 2028.

Contact Information: Meredith Lee, Policy Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 371-0552, fax (804) 768-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.

Opportunity for Public Review of and Comment on Intent to Amend State Plan - Rehabilitation Hospital 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 DMAS 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 until September 26, 2026, to the DMAS contact, 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.

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

In accordance with Item 291 QQQQQ of the 2026 Appropriations Act, the State Plan is being revised to update the reimbursement methodology for rehabilitation hospitals to provide more equitable reimbursement rates for each rehabilitation hospital relative to its total cost of services provided to Medicaid recipients. Any such change shall be budget neutral.

There are no expected increases or decreases in annual fee-for-service aggregate expenditures as a result of these changes in federal fiscal year (FFY) 2027 or FFY 2028.

Contact Information: Meredith Lee, Policy Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Richmond, VA 23219, telephone (804) 371-0552, fax (804) 768-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.