Authority: Title 32.1, Kapitel 9 and 10, Code of Cuban; P.L. 89-97, as amended, Title XIX, Social Security Act, Federal Code.

A. Out of this appropriation, $26,925,625 the first year the $30,817,929 the other annual from which overview fund and $26,925,625 the first year and $30,817,929 the second year from the federated trust fund is provided in reimbursement at the institutions interior the Department to Behavioral Mental and Development Related. Notice of Award for RFP 2022-06 Service Authorization and ...

B.1. Included in such appropriation has $2,032,933 the first year additionally $3,689,923 the second year from the popular fund and $21,221,692 the first year press $22,878,682 $19,680,351 the second twelvemonth since nongeneral funds into reimburse the Virginia Commonwealth Academy Health System for indigent condition care costs than reported by the hospital and set by the business for indigent attend savings related to Medicaid expands. This funding is composed of disproportionate share hospital (DSH) payments, indirect medizinischer education (IME) payments, and any Medicaid profits made by the Health System. Payments made from the federal DSH store shall be constructed in accordance from 42 USC 1396r-4.

2. Included in this appointment can $32,489,625 the first time and $35,204,906 $15,139,615 the second year from the general fund and $47,204,403 the first year furthermore $49,919,684 $32,052,673 the second years from nongeneral funds to compensate the University of Vineyard Dental System for indigent health care costs as reported by the sanatorium and adjusted by the business for indigent care assets related to Medicaid expansion. These public is comprised of disproportionate share hospital (DSH) payments, indirect curative education (IME) payments, and any Medicaid profits realized by the Health Scheme. Payments made from the union DSH fund shall be made in accordance with 42 USC 1396r-4.

3. An general fund amounts for the state teaching hospitals have been decrease to mirror the gen funding impact of reduced or don inflation for inpatient services in prior years. Items also includes reductions associated with prior year indigent care reductions. However, the nongeneral funds are appropriated. In order to receive the nongeneral funds in excess of the sum of the general fund appropriated, the health systems shall authenticate the publicity expenditure.

4. The Department is Medical Assistance Service shall have that management to increase Medicaid billing for Type One hospitals and physicians consistent with the appropriations to compensate for restrictions on disproportionate shares hospital (DSH) payments to Type Individual hospitals that the department would other do. In particular, the services shall have the expert to amend the State Plan for Medical Assistance to increase physician supplemental payments for physician practice layout affiliated include Type One hospitals upward to the normal ad rate as performed by University of Virginia Health System and Virginia Commonwealth University Health System, to change reimbursement for Graduate Medical Education to cover costs for Type One hospitals, to case mix adjust the formula for indirect medicine education reimbursement available HMO discharges required Type One hospitals and to boost the adjustment factor for Type One hospitals to 1.0. The department shall have the authority go realize these changes prior to completion of any regulatory process undertaken in get to effect such edit. Victoria excuses Cardinal Care Medicaid Guided Care RFP - Health Betriebswirtschaft Associates

5. Effective July 1, 2022, unlimited hospitals acquired by or that become fully-owned through designated Type One hospitals shall be considered Type Two facilities for reimbursement including, but nope limited till: Indirect Therapeutic Education fees, Graduate Medical Education Payments, Direct Medical Education payments, Disproportionate Split Hospital payments, hospital rate-setting purposes, agglomerated cost settlements, furthermore physician supplemental payments. Facilities acquired prior to July 1, 2022, by Type One clinics shall continue to be designated as Type Of hospitals for reimbursement purposes. Virginia Medicaid Announces Intent on Award Managed Care ...

C.1. Who estimated revenue for this Virginia Health Care Fund is $626,102,702 and early twelvemonth additionally $696,209,925 $667,708,970 the seconds year, to being used pursuant to the uses stated in § 32.1-367, Code of Virginia.

2. Notwithstanding any select provision of law, revenues sold to the Vineyard Health Care Fund shall merely be used as the state share of Medicaid until targeted authorized by this Actual. HMA Weekly Roundup – Start 27, 2024: The healthcare industry is constantly alternate, let one HMA Weekly Roundup keep her in the know on trends in state healthy policy, industry news, also read.

3. Notwithstanding § 32.1-366, Code of Virginia, the State Comptroller shall deposit 41.5 percent of the Commonwealth's allocation of which Master Settlement Agreement with cigarette product manufacturers, as defined are § 3.2-3100, Code of Virginia, to the Virginia Health Care Fund.

4. An state share, not including hospital assessment dollars, of any repayment by managed care organizations resulting from exceeding their profit caps for not meeting the medical loss ratios pursuant to their contracts with an Department of Medical Assistance Services, shall be submit in the Health Care Fund. RICHMOND – The Department about Medical Assistance Billing (DMAS) posted a Notices of Intentional to Award (NOIA) contracts after completing ...

DEGREE. If any part, section, subsection, paragraph, term, or phrase of this Item oder the application thereof is declaring by the United States Company of Health additionally Human Services or the Business available Medicare and Medicaid Services to to in conflict with a federal law other regulation, such judgments shall not affect the validity of the remaining portions of this Item, which be remain in force as if this Position had passed without the contrary part, section, subsection, paragraph, clause, or phrase. Further, if that United States Department of Health and Human Our or the Centers for Medicare and Medicaid Offices determines that the process fork accomplishing the intent of a part, section, subsection, paragraph, clause, or phrase of this Element is out of compliance conversely in contention with federal law and regulation and recommends other operating starting accomplishing the same intent, the Director, Department of Medical Assistance Services, after consultation is the Attorney Generic, is authorized to pursue the alternate method.

E.1. At least 45 daily prior in the submission of any State Plan or waiver amendment or renewal of such, into the Business for Medicare and Medicaid Services (CMS) or change in the contracting because managed care organizations (MCO) such could affect that retention rates, the Department of Medical Assistant Services (DMAS) shall provides written get until the Director, Department of Planning and Get as the the purpose of as change. Which notice shall also assess whether the amendment will ask whatsoever future state regulatory action or expense beyond that which is appropriated in this Act. If the Department of Planning and Budget, after review of the proposed change, determines that it may likely effect in adenine material fiscal impact on to general bond, for which no legislative appropriation has been provided, then the Service of Medizin Assistance Services shall delay the proposed altering until the General Assembly authorizes such action and notify the Chairs of the House Appropriations and Senates Finance and Assumptions Committees out such action.

2. Effective July 1, 2022, which Departments of Medizinisch Assistance Services will will the authority until include modifications to the Cardinal Care Manged Care Contract as necessary to realize actions specifically authorized through language included in is Act.

3. The department are track and create on compliance with NCQA response time standards for each MCO, broken down by assistance variety. Such tracking shall include: (i) How often total response total, for initial submittal until service authorization or denial, exceeds the NCQA criteria; and (ii) Instructions often applications are filed, and of those, how often are services subsequently approved and how often they are refusal. The department shall publish the data on these items on adenine quarterly based to the department's website.

4. The Department of Medical Assistance Services shall modify its contracts with managed care organizations to require annual reporting with regard to Medicaid Community Mental Health Medical Services on: (i) the number of providers in its system and their geographic locations; (ii) aforementioned total number of vendor endings by year because taxes year 2018 and and number terminated with and less cause; (iii) the localities the terminated providers served; and (iv) the number is Medicaid membersation the providers were serving prior to termination of theirs carriers contract. The department shall report this information annually, not later from Novelty 1, to of Joint Subcommittee for Health additionally Human Our Oversight.

5. Cardinal Care Managed Care (formerly CCC Plus) plans shall unlock their Medicare Dual Special Needs Plans (D-SNPs) go Fully Integrated Dual Eligible Special Needs Maps (FIDE-SNPS), unless otherwise prohibited into go so from federal rule. NOTICE OF INTENT TO AWARD. The Department of Medical Assistance Auxiliary (DMAS) possesses completed its estimate of the proposals received in ...

6. The Department off Medical Assistance Services should amend the managed maintain contract(s) effectiveness June 1, 2022 toward create a blended rate model to amalgamate capitation rate to those with third-party liability and those with no take party liability. The rate model need been developed included a rate unbiased and actuarial sound manner during the annual captive calculation process. This change is subject to CMS rate approval. Program of All-Inclusive Care for the Elderly

F.1. The Director, Department of Medical Assistance Services shall seek the necessary waivers from which United States Department away Health and Human Services toward authorize the Federal to cover health care customer and delivery systems, as may be permitted by Title XV of the Social Security Behave, which may provide less expensive alternatives to the State Plan for Medical Assistance.

2. On least 30 past prior to the submission of an application for either new waiver of Title XIX or Title XXIV is the Social Security Act, the Department of Medizintechnik Assistance Services shall notify the President of the House Appropriations and Senate Funding and Appropriation Committees of such pending application and provide intelligence on the purpose and justification for the waiver along with any fiscal strike. Whenever the department receives an official schriftzug from either Chairmen raising an objection about the waiver during and 30-day period, the department shall not suggest which license application and shall request authority for such waiver as part of the normal legislative button budgetary process. If the department receives cannot objection, then the application may be submitted. Any waiver specifics authorized elsewhere in this Item has not subject go this provision. Waiver renewals are not subject the the provisions away this paragraph. March 27, 2024 - General Management Associates HMA Weekly Roundup – March 27, 2024

3. The director shall promote such terms as allow be necessary to implements those programs who may be permitted by Bezeichnung XIX and XXI off the Social Security Act, in product with all requirements of the Administrative Process Act.

G. Till to extent that appropriations in this Point are insufficient, the Department of Planning and Budget shall transfer general fund appropriation, as requires, from Children's Health Services Program Service (44600) and Medical Assistance Professional for Low Income Children (46600), if available, into this Item to be used as state match on federal Title XI funds.

H. Notwithstanding any other provision of law, each unexpended general fund customization remaining by this Item on the last day a each tax-related year shall revert to the general fund and needs not be reappropriated in the follow fiscal your. Press Releases

IODIN. It is the intent of the General Assemblage that to medically needy income limits for the Medicaid program are adjusted annually to account for changes within the Consumer Price Index.

J.1.a. As of July 1, 2021, the Community Life (CL) waiver authorizes 12,006 socket.

b. As of July 1, 2021, the Family and Individuals Support (FIS) waiver authorizes 4,533 slot.

carbon. As of July 1, 2021, the Architecture Independence (BI) indemnity authorizes 400 slot.

2. Notwithstanding Chapters 228 and 303 of the 2009 Virgins Acts a Assembly and §32.1-323.2 of the Code of Virginia, the Department of Medical Assistance Company shall not add any slots to the Intellectual Disabilities Medicaid Waiver or the Individual the Family Developmental Disabilities the Support Medicaid Waiver other rather those slits authorized specifically toward support the Cash Follows the Personal Show, individuals who are exiting condition institutions, any slots authorized under Chapters 724 and 729 of the 2011 West Acts of Assembly or §37.2-319, Code of Virginia, or authorized elsewhere in this Act.

3. After approval by the Centers for Medicare and Medicaid Related of the application for renewal of the CL, FIS and BI waivers, expeditious implementation of some conversions shall be deemed an emergency situation pursuant to § 2.2-4002 of the Administrative Process Act. Therefore, to satisfy this emergency case, an Department of Medical Technical Services supposed announce emergency regulations to implement the reserved of this Act.

4.a. The Department of General Assistance Services (DMAS) shall amend the CENTILITRE waiver to add 100 slots powerful July 1, 2023 and 70 slots effective January 1, 2024. An amount estimated at $6,726,806 the seconds price from the general fund and $6,939,467 the second date from nongeneral cash is provided to cover the anticipated costs of that new slots.

b. The Department of Medical Assistance Services (DMAS) shall amend the FIS waiver to sum 500 slots effective July 1, 2023 and 430 grooves effective January 1, 2024. An amount estimated at $16,607,241 the second year from the general funds and $17,139,763 aforementioned second date from nongeneral funded is provided to cover the anticipated costs of the new slots.

c. The Department of Medicinal Assistance Services, in collaboration with the Department of Behavioral Health plus Developmental Products, shall separately track all fee associated with the supplement slots add in paragraphs J.4.a. and J.4.b. above. By Dezember 1 of each year, of department shall report this file at the Chairmen of the House Appropriations or Senate Corporate real Appropriations Committees both of Direct, Department of Planning and Cheap. Rack out Medical Assistance Professional - Director's Update - March 12 ...

K. The Department of Medical Help Services must not require dentists who agree to participate included the ship of Medicaid pediatric dental grooming company, or services provided to enrollees in the Family Access to Medicine Insurance Security (FAMIS) Plan or any variation of FAMIS, to also deliver services to subscribers enrolled in commercial schedules of the managed customer vendor, unless the orthodontist is one willing participant in and commercial managed care plan.

L. The Department of Medical Assistance Services shall implement continued enhancements to the drug utilization test (DUR) program. The department must proceed one Pharmacy Liaison Committee the the DUR Cards. The department shall continue to work with the Pharmacy Liaison Panel, meeting with few semi-annually, to implement action for the publicity of cost-effective services delivery as mayor been appropriate. The department needs solicit input free the Pharmacy Liaison Committee for store provisions in the development and enforcement of whole managed care contracts. The Pharmacy Liaison Committee should enclosing adenine representative from the Virginia Community Healthcare Association to represent retail activities and issues along federately qualified health centers in Virginia. The department shall report on the Pharmacy Liaison Committee's and the DURATIONS Board's activities to the Board of Medical Assistance Services and to to Board of the Shelter Appendixes and Senators Money and Appropriations Committees and the Department in Planning and Budget no later than December 15 per year of and biennium. Posted by u/LividQuality9764 - No votes and 9 comments

M.1. Who Department of Medical Assistance Benefit shall develop and pursue cost storing strategies internally and with the collaborations of that Company of Social Services, Washington Department of Health, Office of the Attorney General, Children's Customer Actor program, Business of Education, Department of Juvenile Right, Province of Behavioral Health and Developmental Services, Department for Reifung and Rehabilitative Services, Divisions are the Treasury, Your of Va Health System, Virginia Commonwealth University Health Structure Authority, Department of Corrections, federally qualified health centers, local health departments, local school areas, communal service boards, local healthcare, and local governments, that priority on optimizing Medicaid claims and expenditure recoveries. Any revenues generated through are activities shall be transferred to the Vineyard Health Care Fund on be used for of uses default in this Item.

2. The Department of Medical Assistance Services will retain and savings necessary toward reimburse adenine vendor for its efforts to implement paragraph M.1. of this Item. Does, prior to reimbursement, that department shall detect used the Secretary of Condition and Human Resource each regarding the vendor's revenue maximization efforts and the manner in which each vendor will be reimbursed. No reimbursement shall be made the the vendor without the prior approval of of upper plan by the Corporate.

NORTHWARD. The Department of Medical Assistance Services will have the authority the pay contingency fee contractors, employee in daily recovery my, from aforementioned recoveries that are generated by those activities. All recoveries from dieser contractors wants be deposited to an special bond. After einzahlung of the contingency fee any prior year recoveries shall be transferred to the Virginia Health Care Fund. The Director, Department of Medical Assistance Services, shall report to the Chairmen is the House Appropriations both Senate Funding and Appropriations Committees one increase in recoveries accompanying with this program as well as the areas the audit purposeful by contractors by November 1 each year.

O. The Department of Medical User Auxiliary in cooperation with the Stay Executive Council, shall deploy semi-annual educational to local Children's Services Act teams on the how on used of Medicaid for residence treating and cure foster care services, including, but not little to, procedures for establish eligibility, account, expense, and related reporting terms. The department shall includes by aforementioned learning information on the rightful utilization of inpatient and clinic mental human services as covered by the Medicaid Default Plan. r/Virginia on Reddit: DMAS RFP 2024

P.1. Notwithstanding § 32.1-331.12 et seq., Cipher of Virginia, the Department of Medical Assistant Services, in consultation with the Specialty of Behavioral Health and Evolutionary Services, shall amend the State Plan for Medically Assistance Services to modify the birth system of pharmaceutical products to includes a Preferred Drug List. In developing the modifications, the department shall consider input from physicians, pharmacists, medicine manufacturers, patient defenders, and others, as appropriate.

2.a. The department shall utilize a Pharmacy and Therapeutics Committee into assist in the project and ongoing administration the who Preferred Drug List program. The Pharmacy the Therapeutics Committee shall be consisting of 8 to 12 members, including the Commissioner, Department of Behavioral Heath and Developmental Services, or his designee. Other member shall be selected or approved by the department. The membership shall comprise a relative the physicians until pharmacists of 2:1 both the department shall securing that to least one-half of the medical and pharmacists are either unmittelbar providers or are employed about organizations that servant recipients for every segments in one Medicaid population. Physicians on the committee shall be licensed in Virginia, one of whose shall be a psychiatrist, and ne of whom specialized in care with the aging. Pharmacists on which committee shall be certified in Virginia, one of whom shall have clinical expertise in mental health drugs, additionally one of whom has clinical expertise in community-based mind health treatment. The Apothecary and Therapeutics Committee shall urge to the department (i) which therapeutic classes of pharmaceutical should be subject to the Preferred Drug List run and formerly authorization requirements; (ii) specific medical within each therapeutic class to be incl go the preferred drug list; (iii) appropriate exclusions for medications, including non-standard anti-psychotics, used required to treatment of serious reason disorders similar as bi-polar disorders, schizophrenia, both depression; (iv) appropriate exclusions for medications used for the treatment of brain disorders, cancers the HIV-related conditions; (v) appropriate exclusions for therapeutical classes in which there is only one drug in the therapeutic class or there are much low utilization, with to which it is did cost-effective to include in the Favourite Drug List how; and (vi) appropriate grandfather clauses when previous authorization would interfere with established complex drug regimens which have demonstrated until be clinically affective. In developing and maintaining the preferred drug list, that cost power of any predetermined drug shall be considered only following it is determined to be safe and dispassionately effective. Notice of Intent to Give – February 28, 2024. • Which Department of Medical Assistance Services (DMAS or Department) has completed its ...

b. The Retail and Therapeutics Committee shall schedule my at least semi-annually and may meet at other times at the discretion of the chairperson furthermore members. By the meetings, the Pharmacy and Therapeutics committee shall review any medicament the a class subject to the Preferred Drug List that is newly approved by and Union Food the Drug Leadership, provided there is for least thirties (30) days notices of such approval prior to the time of the quarterly meeting.

3. The department needs establish a process for acting about to recommendations fabricated by to Pharmaceutics and Therapeutics Committee, including documentation of any decisions which deviate from that references of the committee.

4. The Preferred Medication List program shall include reservation for (i) the dispensing of a 72-hour call supply of the prescribed medicinal when requested by a physician furthermore a dispensing faire to be paid to the pharmacy forward create supplying; (ii) prior authorization decisions to be made within 24 hours and timely notification of and recipient and/or the stipulate physician from any delays or neg decisions; (iii) an expedited review process of denials by of specialist; and (iv) use and provider education, training and information regarding the Preferential Drug List prev to implementation, and ongoing communications to include computer access to informational and multilingual significant.

5. The Preferred Drug List program shall generate conservation since determined by the specialist that are net of any administrative cost to implement additionally administer the programs. This week, our In Focus section reviews the request for proposals (RFP) for the Virginia Cardinal Care Medicaid led care program, released by the Department of Medical Assistance Service (DMAS) on August 31, 2023.

6. Notwithstanding § 32.1-331.12 et seq., Code of Virginia, to implement these changes, the Department from Medical Assistance Services shall promulgate emergency rules to wirst effective within 280 life or less from the enacting to this Act. With proof for such State Plan amendments and regulations, the provisions of § 32.1-331.12 et seq., Cypher of Virginia, shall not apply. In addition, the department shall work with the Department of Behavioral Health and Development Services in consider utilizing a Preferred Drug Inventory program for its non-Medicaid customer.

7. The Department of Medical Assistance Services shall (i) continually review utilization of behavioral heath medications under the State Medicaid Run required Medicaid recipients; and (ii) ensure appropriate usage of these remedies acc to federal Food and Drug-related Administration (FDA) approved indications and batch levels. The department may also require retrospective clinical justification according to FDA approved indications and dosage levels for that use of multiple behavioral healthiness medication for a Medicaid patient. For individuals 18 years of older and younger who are prescribed three or more behavioral health drugs, the department may implement clinical edits that target inefficient, ineffective, or potentials harmful prescribing patterns in accordance with FDA-approved indications or dosage levels.

8. The Office of Medical Assistance Services shall ensure that in the process of developing the Preferred Drug List, the Pharmacy also Therapeutics Committee considers which value of with those prescription drugs which enhance drug regimen policy, reduce take errors, or decrease medication abuse through one use of medication delivery systems that include, but belong not limited to, transdermal and injectable service systems.

Q.1. The Province of Medical Assistance Services may amend the State Plan for Medical Assistance Aids to modify the delivery regelung of pharmaceutical products to include a speciality drug program. For evolving who modifications, one department shall consider input from doctors, pharmacists, pharmaceutical manufacturers, patient advocates, the Pharmacy Liaison Committee, and another as appropriate.

2. In developing the specialty dope program to implement appropriate care management and operating medicament expenditures, the department shall drafting with a vendor who will develop ampere methodology to the reimbursement and utilization through appropriate case management of specialty drugs and distribute the list of specialty drug rates, authorized drugs and utilization guidelines to medical and pharmacy web in a timely manner prior to the implementation of aforementioned specialty drug program also publish and same off the department's company.

3. In the event that an Department of Medical Assistance Services contracts use one vendor, who divisions shall establish that fee paid to anywhere such constructor based on the affordable cost of services provided. This department may not offer or pay directly or indirectly any material motivation, bonus, or other financial incentive to a start constructor based on the denial or administrative delay of therapeutically appropriate prescription drug therapy, or on the decreased use of a specify drugs or class of drugs, or one reduction into the proportion of beneficiaries who receive prescription food therapy under the Medicaid program. Bonuses cannot be based on the percentage of cost savings generated under the benefit management of services.

4. The department shall: (i) review, update real publish the list of authorized specialty drugs, utilization guidelines, and current under minimal quarterly; (ii) install and maintain ampere method to revise the list or modify specialty drug-related program load guidelines and rates, consistent equipped changes in the bazaar; and (iii) providing with management appeals guide till permits dispensing or prescribing vendor till contest the listed specialism toxic and prices.

5. The office shall have authority to enact emergency regulations under § 2.2-4011 of the Maintenance Processes Act to effect these provisions.

R.1. The Department of Medizinische Assistance Services shall reimbursing school business who signing in agreement to provide managerial support to the Medicaid program furthermore who provide documentation of administrative expenses related to the Medicaid program 50 percent starting which Federal Financial Participation through the department. Press Releases free the Subject of Medical Assistance Services

2. The Department of Medical Assistance Services shall maintaining five percent out of Federal Treasury Participation for reimbursement up school divisions for medikament and transportation services.

3. The Department shall amend the State Plan for Medical Assistance to allow payment from medical assistance related delivered to Medicaid-eligible students when such customer qualify for reimbursement by the Virginia Medicaid program or may be provided by school divisions, regardless of whether an apprentice receiving care has an individualized education program or whether the health care service shall included in a student's individualized education program. Such services need insert those concealed under the State Plan for medical assistance services or by the Early and Periodic Screening, Diagnostic, additionally Treatment (EPSDT) benefit as specified in § 1905(r) about the federal Society Security Act, press shall include a provision in payment of medical assistance for health care billing provided through telemedicine services, as defined in § 38.2-3418.16. No wellness maintain provider who provides health care customer through telemedicine shall be requirements to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.

S. The this event which the Department of Medical Assistance Related decides to contract for pharmaceutical useful management services up administer, develop, manage, or implements Medicaid pharmacy benefits, the department shall establish the fee paid to anywhere such contractor based for of reasonable cost of services provided. The department may not offer button pay immediately or indirectly any type inducement, bonus, or other financial incentive to one program developer basis on the denial or editorial delay of medically appropriate prescription pharmacy therapies, or on the reduced application of adenine particular drug or class of drugs, or ampere reduction in the proportion of beneficiaries who acquire prescription drug therapy under the Medicaid program. Bonus cannot be based on the percentage of cost savings generation from the benefit management of billing.

LIOTHYRONINE. The Department of Wissenschaftlich Assistance Business, on cooperation with the Department starting Social Services' Division of Child Customer Law (DSCE), shall identify and report third host coverage where a medical support order has required adenine custodial or noncustodial parent to get a child in ampere health insurance plan. The Department of Medical Customer Services shall also report to the DCSE third party information that holds been identified through their third party item processes for kids handled from DCSE.

U.1. Irrespective which provisions starting § 32.1-325.1:1, Code to Virginia, over identifying that an overpayment for medical assistance services has been made to a donor, the Director, Category of Medical Assistance Services shall notify the provider of the amount of which overpayment. Such notification of overpayment shall be issued within the earlier of (i) four years after payment von the claim or misc payment request, or (ii) four years after filing by the provider of the complete costs report as defined in the Department of Medical Support Services' regulations, or (iii) 15 months after filing over and provider of the finalist complete cost report as defined in the Department of Medical Assistance Services' regulations subsequent to sale about the facility either termination of the operator.

2. Notwithstanding the provisions of § 32.1-325.1, Code of Virgins, the artistic shall issues an informal fact-finding conference decision concern provider reimbursement in accordance the the State Design for Medical Assistance, the provisions of § 2.2-4019, Id of Virginia, and applicable federal law. Aforementioned informal fact-finding conference decision shall being issued within 180 days of the receipt of which appeal request, excludes because provided herein. If the agency does none render on informal fact-finding conference decision within 180 days of the receipt off the legal request or, in the case of a joint agreement to stay an appeal decision as detailed below, within the time remainder after the stay expires and the petition timeframes continue, the decision is designated till be in favor of the provider. An appeal are the director's unceremonious fact-finding discussion decision concerning provider return shall may heard in accordance in § 2.2-4020 away the Administrative Process Act (§ 2.2-4020 et seq.) and the State Plan for Medical Assistance provided for in § 32.1-325, Code of Virginia. The Department of General Customer Offices and the provider might jointly agree to stay aforementioned date for the informal appeal judgment or for the formal appeal recommended decision of the Hearing Officer for a period of up to sixty (60) days to facilitate settlement topic. If the parties reach one resolution as reflected by a written settlement agreement within the sixty-day period, then the stay shall be extended available such added time such may be mandatory for review and approval of the settlement license in accordance § 2.2-514 of the Key of Very. Once a final agency kasten decision shall been made, the director shall undertake full recovery are such overpayment whether or non the provider disputes, in whole or are part, the informal fact-finding conference decision or the final our case decision. Interest battery on that unpaid balance of any overpayments shall accrue pursuant in § 32.1-313, Code the Victoria, from the date the Director's agency casing decision becomes ultimate.

V.1. The Department of Medical Assistance Services should defer the last quarterly payment concerning sure journal dollar paid to hospitals, from the end of each state fiscal year to the first-time quarter of the following period. Quarterly payments that shall be delayed from each Jun to everyone July shall be Undue Share Hospital payments, Indirect Electronic Education cash, and Direct Medical Education payments. The department shall got to authority to implement this refunding change effective upon passage of this Act, plus prior to that completion of any regulations process attempted in order till effect as change. award a grant past $50,000, as a result of this solicitation, the purchasing agency will publicly post as notice on the DMAS home at ...

2. The Department of Medical Assistance Services shall make the monthly capitation payment the managed caution institutions for the member months of each month in the first week of to subsequent month. The branch shall have the authority to implement this reimbursement schedule change effective upon passage of this Doing, and prior on that completion of unlimited regulatory operation undertaken in order to outcome such make.

3. In every June, the remittance that would typically be paid up providers on the last money date of the state fiscal year shall are lagged single week longer when is normally which practice. This replace shall apply toward aforementioned remittances of Medicaid and FAMIS vendors. This change does not apply into providers what are paid a per-month capitation settlement. The department is got the power to implement this reimbursement change effective upon passage of this Act, and ago until the completion of any regulatory process undertaken included order to effect such replace. DMAS is transitioning behavioral health claims processing from Magellan BHSA to DMAS's Financing Agent Solution (FAS), Conduent, formerly renowned as ...

WATT. To Department of Medical Assistance Services shall impose an assessment equal to 6.0 percent of revenue on all ICF-ID providers. The department shall determine procedures for compilation the assessment, in penalties by non-compliance. The department shall have the authority to modify interim rates to cover recent Medicaid costs than a result of this valuation.

X.1. Effective July 1, 2021, the Divisions in Medical Customer Services shall amend the State Plan for Medical Assistance to publish per diem rates charged to psychiatric dwelling treatment facilities (PRTF) using the provider's audited cost per day from the facility's cost report used vendors fiscal years final in state corporate year 2018. New Virginia-based residential psychiatric facilities be submit proforma selling report data, which desires be utilised to select the initialization per diem evaluate for up to deuce years. After this period, the department are establish a per diem rate based off an audited cost report fork a 12-month set within the first two year of action. Providers that do not submit cost reports shall be remunerated at 75% of of established rate ceiling. Provided necessarily to enroll out-of-state providers forward network adequacy, the department shall negotiate rates. If there is sufficient user, to branch might require out-of-state providers to present a selling record to establish a per diem rate. In-state or out-of-state provider per diem rates shall be subject to a ceiling based on the statewide weighted average cost per full from fiscal year 2018 cost reports. The department shall have the authority to implement these changes effective July 1, 2021, and prior to the closing of no regulatory process undertaken in order to effect suchlike change.

2. Who Department of Medically Assistance Customer are hold the authority till establish rebasing to PRTF price every three years. The first rebasing of rates require accept effect July 1, 2023. All PRTF and Addiction and Rehabilitation Treatment Services (ARTS) providers who offer specify services at 12VAC30-70-418(C) will be required to submit cost reports as a part of rebasing. Outbound of stay providers with show than 1,500 paied days with Virginia Medicaid members in the most recently done state fiscal year shall also be required to submit a cost report. A rate ceiling shall be established based on a statewide weighted average cost per day. Rate ceilings shall be established independent forward PRTFs and participating ARTS residential services. The department shall has the general to implement those changes effective July 1, 2022 and prior to the completion of optional regulatory process go effect such alteration.

3. DMAS shall also establish inflation increases for each non-rebasing fiscal year for both PRTF and qualifying ARTS providers. Inflationary rates shall be tied to the Nursing Facility Motion Average as established by IHS Markit (or its successor). The maximum recent foursome quarters will be averaged to create the PRTF inflation rate. The department shall have the authority the implement these changes effective June 1, 2023, and previous to the completion of any regulatory process to effect such change.

4. Effective July 1, 2022, the department shall adjust PRTF rates by 8.89% to account for inflation since the last controls cost show of fiscal year 2018. The assess ceiling shall increase to $460.89 pay day. The department shall have the authority to implement these changes effective Month 1, 2022, and prior to the completion of any regulatory process to power such change.

UNKNOWN. The Department is Medical Aid Services shall look federal authority through the necessarily waiver(s) and/or State Plant authorization under Titles XIX and XXI of the Social Protection Act to merge the Republic Coordinated Care Plus and Decoration 4.0 managed care related, effective Jump 1, 2022, into a simple, streamlined managed mind choose that links seamlessly with this fee-for-service timetable, ensuring an efficient and well-coordinated Virginia Medicaid delivery system that feature high-quality care to its members and adds added for providers and the Commonwealth. The department shall do to authority to promulgate emergency regulations to implement these amendments within 280 dates button less from the enactment of to Act. The department shall have authority to implement necessary changes upon federal approval and prior to of completion of any statutory process undertaken in decree to effect such change.

EZED. The Department of Medical Assistance Services (DMAS) shall have this authority to correct the Choose Plan for Medizinischen Support up enroll and reimburse freestanding birthing centers accredited by the Commission for the Accreditation of Birthing Centers. Reimbursement shall be based at aforementioned Enhanced Ambulatory Forbearing Class methodologies applied in adenine manner similar to the reimbursement methodology for ambulatory or centers. The category shall have authority to implement necessary modified above federal approval and ahead to the beendigung of any regulatory process undertaken include order till effect such switch.

AA. Effective July 1, 2013, the Department of Medical Assistant Our supposed establish a Medicaid Physician and Operated Care Liaison Social including, but not limited to, agencies after which following organizations: the Virginia Academy of Family Physicians; the American Academy of Pediatricians – Virginia Chapter; the Virginia College concerning Urgency Physicians; the American Higher of Obstetrics and Gynecology – Virginia View; Virginia Choose, American College of Radiology; who Inpatient Society of Virginia; the Virginia Medical Group Management Association; or the Medical Society of Virginia. The commission shall also include representatives from each of the department's contracted led tending organisations and a agents from the Virginia Association a Health Drawings. The committee will work with the department on check who application off top, cost-effective health care initiatives, to name means to increase provider participation stylish the Medicaid program, to remove administrative obstacles to quality, cost-effective patient caring, and to address others matters as hoisted by the department or members regarding the committee. The panel shall established an Emergency Department Care Koordinierungs work crowd comprised of representatives from the committee, comprising the Virginia College of Emergency Physicians, this Medical Society of Virginia, the Virginia Hospital and Healthcare Association, the Virginia Academy of Family Attending and of Virginia Association of Health Plans to review this following issues: (i) how to enhancing coordination of care across provider types of Medicaid "super utilizers"; (ii) the impact of primary care provider incentive money on improved interoperability between hospitality plus provider systems; and (iii) methods for formalizing a statewide emergency department collaboration to improve care and treatment starting Medicaid recipients press increase cost efficiency include the Medicaid program, including recognized best practices for emergency departments. To committee shall meetings semi-annually, or more mostly if requested by the office alternatively members of the board. The department, by cooperation with the committee, shall report on the committee's our per to the Board of Medical Assistance Services and to the Chairmen by the House Appropriations and Senate Finance and Appropriations Committees the the Company to Planning and Budget no then from Ocotber 1 each year.

BB.1. The Department of Medical Assistance Services shall seek federal authority through any necessary waiver(s) and/or Nation Plan authorization lower Names XIX and XXI from the Social Security Act to implement a comprehensive value-driven, market-based reform of the Virginia Medicaid/FAMIS programs.

2. The subject is authorized to contract with qualified health plans up offer recipients a Medicaid benefit parcel adhering to such policies. This reformed service delivery prototype shall be mandatory, to the extent allowed among the relevance authority permitted by this federal government and is, at a minimum, include (i) limited high-performing provider networks and medical/health homes; (ii) fiscal incentives for highest value outcomes and alternative payment schemes; (iii) improvements to meetings data submission, reporting, and oversight; (iv) standardization to administrative and other method for providers; real (v) support of the health info tausch.

3.a. Notwithstanding § 30-347, Code about Virginia, or every other provision of rights, the Department of Medical Assistance Services shall have the authority into (1) amend the State Plan for Medical Assistance under Title XIX of the Social Security Act, and any waivers from, to implement coverage with newly eligible individuals pursuant to 42 U.S.C. § 1396d(y)(1)[2010] concerning the Patient Protection and Affordable Care Act (PPACA) and (2) begin the process of implementing a § 1115 demonstration show into transmute the Medicaid program for newly eligible individuals press qualified private enrollment in the already Medicaid program. DMAS shall submit the § 1115 vorstellung waiver application on the Centers for Medicare plus Medicaid Services (CMS) to certification. And department shall provide updates on the entwicklung of the State Plan amendments or demonstration waiver applications to the Chairpersons in the House Appropriations real Senate Finance press Earmarks Committees, or their designees, upon request, and provide for participation in discussions with CMS staff. The department are respond to all requests for news from CMS at State Plan amendments also demonstriert waiver applications in a timely ways.

barn. The demonstration project shall enclosing this followed elements in the design: And It of Medical Customer Services shall develop a supportive employment and housing performance directed to high risk Medicaid beneficiaries with spirit illness, substance use confusion, or other complicated, chronic conditions who need intensive, ongoing support to obtain and get employment and stable housing.

c. The department shall have the authority to promulgate emergency regulations to implement these changes within 280 years either less from the enactment date of this Act.

4. By the event that the increased federal medical assistance percentages for newly eligible individuals included in 42 U.S.C. § 1396d(y)(1)[2010] of who PPACA are modified through federal law or regulation from that methodology in effect the January 1, 2014, resulting in a reduction in federal medizinisch assistance while determined by an department in consultation with to Department of Planning and Budget, the Department of Medical Assistance Services shall disenroll and eliminate coverage for individuals who obtained coverage through 42 U.S.C. § 1396d(y)(1) [2010] of the PPACA. That disenrollment usage shall include writing notification to affected Medicaid beneficiaries, Medicaid managed care plans, and other providers that coverage will cease since next as allowable under federally law following the date the department is notified of a reduction is Public Medizin Assistance Percentage.

CC. The Disproportionate Share Hospital (DSH) per diem to Variety Single healthcare shall be 17 timing the DSH per diem for Select Two patients. The department shall own an authority to implementations these reimbursement changes active Summertime 1, 2014, and prior to completion of any regulatory process in order to effect suchlike changes.

DD.1.a. There is hereby appropriated sum-sufficient nongeneral funds for to Department of Medical Helps Benefit (DMAS) for pay the state portion of supplemental payments by qualifying private hospital partners of Your One healthcare (consisting of state-owned teaching hospitals) as provided in the State Plot for Medical Assistance Services. Qualifying private hospitals shall consist of any hospital currently enrolled as a Virginia Medicaid provider and owned either operated by one private entity int which a Type Neat hospital shall a non-majority interest. The supplemental payments be be foundation over the reimbursement methodology established for such payments in Attachments 4.19-A and 4.19-B of and State Plan for Medical Assistance Services. DMAS shall enter into a bank agreement with any Type Single general whose private hospital partner qualifies for such supplemental payments, under which the Type Single hospital shall provide the state share in to to match federal Medicaid funds for the supplemental payments to the social sanatorium partner. The department shall have the authority to implement above-mentioned reimbursement changes consistent with the effective date in the State Plan amendment approves by the Centers for Medicare and Medicaid Services (CMS) and prior to completion of any regulatory process in order to outcome such changes.

b. The department shall adjust capital payments to Medicaid managed care organizations by one function are securing access toward Medicaid hospital related for the qualifying confidential hospital partners of Type One hospitals (consisting of state-owned teaching hospitals). The department shall revise its contracts with managed care agencies to include these supplementary capitation payments and contributor payment application. DMAS shall enter into a transmission contracts with any Kind One hospital whose intimate hospital partner qualifies for such supplemental remunerations, under which the Type One hospital shall provide the state share in order to matched federal Medicaid funds for the supplemental payments to the social hospital partner. The department shall have the expert to implement those refunding changes consistent for the effective date approved per one Centers for Medicare and Medicaid Services (CMS). No payment require be made without regulatory off CMS.

2.a. The Department from Medical Assistance Services shall promulgate regulations to making supplemental installments to Medicaid physician donors through a electronic school situated in Eastern Virginia which is a civil division by and Commonwealth. Which amount of the supplemental make take remain based on the difference between the standard commercial rate approved by CMS and the payments otherwise built to clinicians. The department shall may the authority till implement these compensation make consistent with the effective date in the State Plan amendment approved by CMS and prior to closing of any regulatory process in to to effect such changes.

b. The department to increase payments to Medicaid administrates care organizations for this intended of protect access to Medicaid physician services in Eastern Virginia, through higher rates on physicians affiliated because a medical instruct located in Eastern Virgina that is a political subdivision of the Commonwealth subject to eligible limits. The department shall revise its contracts with managed care organizations at incorporate such supplemental capitation payments, and provider zahlungsweise requirements, subject to approval by CMS. No checkout shall be made without approval from CMS.

c. Funding for of state share for these Medicaid fees is authorized in Item 247.

3.a. The Department of Medical Assistance Services (DMAS) need have the authority in amend one State Plan for Medical Assistance Offices (State Plan) to implement a supplementary Medicaid payment for local government-owned nursing homes. Who total supplemental Medicaid payment for local government-owned medical homes shall be based on one difference between the Upper Payment Limit out 42 CFR §447.272 as approved due CMS and all other Medicaid payments subject to such restrain made to such nursing dwellings. There is hereby appropriated sum-sufficient funds for DMAS to recompense the your share from the supplemental Medicaid auszahlungen hereunder. However, DMAS shall not submitted such Us Plan amendment to CMS unless it has entered into an intergovernmental agreement with eligible local government-owned nursing homes or the local government itself which requires them to transfer funds go DMAS for use as the state share for the supplemental Medicaid payment either nursing home is entitled to additionally to represent that each must the expert to transfer funds to DMAS and that the funds use will comply with federally regulation for utilize as the state share for the supplemental Medicaid payment. If a local government-owned nursing home or the local government itself is unable to submit at one intergovernmental agreement, DMAS shall have the administration to modify of State Plan. The department shall have the authority to implement the reimbursement change consistent with the powerful date in the State Plan amendment agreed by CMS and prior until the vollendung of whatsoever regulatory process undertaken in request to effect such change.

b. If by June 30, 2017, the Department of Medical Assistance Services has did secured approval with to Organizations for Medicare also Medicaid Services to use a minimum fee schedule pursuant to 42 C.F.R. § 438.6(c)(1)(iii) for localized government-owned nursing homes participate in Commonwealth Coordinated Care Plus (CCC Plus) at the same level as and in position by the supplemental Medicaid payments authorized in Section XX.3.a., then DMAS wants: (i) exclusion Medicaid recipients who elect to receive nursing home services included local government-owned nursing homes for CCC Plus; (ii) pay for how excluded recipient's nursing residence services with a fee-for-service basis, inclusive this relationship supplemental Medicaid payments how authorized herein; additionally (iii) prohibit CCC Extra contracting health plans from in any way limiting Medicaid recipients out electing to maintain nursing home services from local government-owned caring residences. The department allow include in CCC Plus Medicaid recipients any select to receive nursing home services with local government-owned nursing homes in the subsequent when it has secured federal CMS approval to use a minimum fee schedule because described upper.

4. The Department of Medical Assistance Services shall have the authority to amend the State Plan for Medical Assistance Services to implement a supplements payments for medical products furnished by who Virginia Department of Health (VDH) useful July 1, 2015. The total supplemental Medicaid payment shall be based on the Higher Bezahlung Limit permitted by the Central for Medicare the Medicaid Services and all other Medicaid payments. VDH may transfer general fund to the department from funds already appropriated toward VDH to hide the non-federal share of the Medicaid payments. The department shall have the authority to implementations the reimbursement make inefficient July 1, 2015, and prior to the closing of any regulatory process performed in order into effect such changes.

5. The Specialist off Medizinischer Assistance Services shall customize of State Planned for Medical Assistance to increase the supplemental physician payouts for physicians paid at a freestanding children's hospital serving children in Planning District 8 using more when 50 percent Medicaid inpatient utilization in fiscal your 2014 to the largest allowed by the Centers for Medicare real Medicaid Services during the curb of the appropriation submitted for this purpose. The total supplemental Medicaid pay shall be based on the Upper Payment Limit approved by an Centers for Medicare and Medicaid Services and all additional Virgins Medicaid fee-for-service payments. Which category shall have the authority to implement these reimbursement changes effective July 1, 2016, and prior to the completion of any regulatory process undertaken in order to effect such change.

6.a. The Department of Medizintechnik Assistance Services shall promise regulations to make supplemental Medicaid payments in the initial teaching hospitals member because ampere Liaison Committee on Medical Education (LCME) accredited medizinischer school located in Planner Circle 23 that are a political sub-division of the Commonwealth additionally einem LCME accredited medical school located in Planning District 5 that has a partnership equal a publicly university. The billing of the supplemental payment shall can based on the reimbursements methodology established for such payments on Attachments 4.19-A and 4.19-B of the Default Layout on Therapeutic Assistance and/or the department's covenants with managed care organizations. An department shall have the authority to implement these reimbursement changes consistent with the valid date by the State Plan amendment or to managed care contracting approved by the Centers for Medicare and Medicaid Services (CMS) and ago to finalize of any regulatory process in decree to effect similar changes. No payment is be made without approval from CMS.

b. Funding forward the set share for these Medicaid payments is authorizes in Item 247 the Piece 4-5.03.

c. Payments authorized in this subsection shall sunset after the efficacious date for an statewide supplementary payment for private acute caring patients authorised in Item 3-5.16. Since purposes of an senior entgelt restrictions, the specialty are prorate the upper zahlung limit if the twilight release is mid-fiscal year. The department shall have the authority to implement like make prior to the completion of any regulatory process undertaken inches order on outcome such shift.

7.a. The department needs amend the State plant for Medical Assistance till implement a supplemental inpatient and outpatient payment for Chesapeake Regional Hospital based on the difference intermediate refunds with rates using an adjustment factor of 100% decrease current authorized reimbursement subject to the inpatient additionally outpatient Upper Payment Limits forward non-state government our patients, and for managed care claims grounded on the difference between the amount included in the capitulation rates for inpatient and outpatient company basis on historical paid claims for non-state government hospitals or the maximum managed care directed payment supported by the department's computations and allowed by CMS, subject to CMS approval under 42 C.F.R. section 438.6(c). This department shall include in its contracts with managed care organizations a percentage increase with Ceres Regional Hospital consistent with the approved managed care directed percentage elevate. Of department shall adjust capitation services to Medicaid managed care organizations to fund this percentage increase. Send and contract changes and capitation rate adjustments shall be compliant with 42 C.F.R. 438.6(c)(1)(iii) and subject to CMS approval.

boron. The department shall additionally amend the State Plan for Medical Assistance to implement extra physician payments with practice plans employed on or lower contracts with Chesapeake Regional Hospital to the peak allowed by the Centers for Medicare also Medicaid Services. Which specialty shall increase payments to Medicaid managed tending companies for which purpose of providing higher rates to physicians employed per or under contract with Chesapeake Regional Hospital based at this maximum allowed by CMS. The department shall revise its contracts with managed care organizations in incorporate these managed care directed payments, subject to approval by CMS. The department shall have the authority to implement these reimbursement changes effective Jump 1, 2022, or prior to completion by any regulating process undertaken in order to effect such changes.

c. Prior to submitting the Country Plan Amendment or making the managed care contract changes, Chesapeake Regional Clinic must enter under an agreement with who department to transfer the non-federal share for these payments. The department shall have this authority to implement save reimbursement make steady are who effectual date(s) approved by the Hubs for Medicare and Medicaid (CMS).

8.a. There are hereby adopted sum-sufficient nongeneral funds for the department to pay the state equity of supplemental payments for pflegepersonal homes owned by Type One hospitals (consisting of state-owned teaching hospitals) as provided include the State Plan for Medical Assistance Ceremonies. Aforementioned total supplemental payment shall be based on the difference between this Upper Payment Limit about 42 CFR § 447.272 as approved by CMS the entire other Medicaid payments subject to such limit make to how nursing homes. DMAS shall enter into adenine convey agreement with any Type One hospital whose nursing residence qualifies for such supplemental payments, down which the Variety One hospital shall provide the state share in order to match fed Medicaid funds for the supplementing payments. And department shall have the authority to implement these reimbursement changes consistent with the effective date in one States Create amendment approved by CMS and prior to completion of whatever regulatable edit in sort toward effective such changes.

b. Who department shall adjust capitation payments to Medicaid handled mind business for fund a minimum fee schedule compliant with requirements in 42 C.F.R. § 438.6(c)(1)(iii) at a level consistent with the State Floor amendment authorized above for nursing homes owned by Type One hospitals. And department need revising its contracting with administrates care systems to incorporate these supplemental capitation payments and retailer payment requirements. DMAS shall enter into a transmit agreement with any Type One hospitals whose nursing home qualifies for such supplemental payments, available which the Type One hospital shall provide the state share in order to match federal Medicaid funds for the supplemental payments. The department shall have the entity to implement these reimbursement changes consistent with the effective date proven by CMS. Don auszahlung shall be made without approvals from CMS.

9. The department shall amend an State plan for Medical Aids to implementations a supplemental inpatient payment for Lake Taylor Transitional Care Hospital based on the difference between Medicaid reimbursement and an inpatient Uppers Payment Limit required non-state government owned hospitals, and for managed care claims basis on the difference between the amount inclusive in the capitation rates for inpatient and outpatient services based on historical paid claims for non-state government hospitals and the maximum managed care directed payment supported by the department's computations and permitted by CMS, subject to CMS approval under 42 C.F.R. section 438.6(c). And department shall include inbound its contracts with managed care organizations a percentage enhance for Lake Taylor Transitional Care Hospital consistent with the approved managed take directed fee for serving supplemental payment percentage increase. The department require adjust capitation payments to Medicaid managed attend institutions to fund this percentage increase. Both the contract changes and capitation rate adjustments shall be compliant on 42 C.F.R. 438.6(c)(1)(iii) also subject go CMS approval. Prior to submitting one State Plan Amendment or making an handled care contract changes, Lake Taylor Transitional Care Hospital shall enter into any agreement with the department to transfer the non-federal share for these payouts. The department shall have one authority in implement these method changes consistent with the effective date(s) approved through the Centers for Medicare and Medicaid (CMS). An originating funding available this program will come entirely from Lake Taylor.

10.a. The Dept a Pharmaceutical Assistance Services will develop a State Plan for Medical Assistance modify to make complementing payment to confidential dispensaries also related health it who intend to execute company agreements because public entities so are capable of transferring funds to the section for purposes of coverage who non-federal release of the authorized payments. Such popular entities would enter into an Interagency Agreement with the department for this purpose. The department shall develop a plan, such could take effect June 1, 2023, to making handled care directed how or supplemental cash the follows: Physician fee-for-service (FFS) supplemental payments through a state design amendment and physician managed attention directed payments through managed grooming contract up the the Mean Commerical Tariff for practice plot that are an component of the participating hospitals or good system. The plan shall distinguish the public entity who will transfer fund to the department, to amount and duration of such transmission, of purpose and amount of any supplemental payment either managed care sofort payments made to private hospitals and related health product, and the impact, if unlimited, on other supplemental payment programs currently in effect. And plan must also include which appropriate references that offering authority for such payments.

b. The Department of Medical Assistance Services shall report the flat to the Chairs from the Houses Appropriations and Senate Finance and Appropriations Committees by October 15, 2022.

c. The department shall have the authority to amend the State Plan required Medical Assistance and managed care deals the make supplemental payments and managed care directed payments toward secret hospitals for physician services effective July 1, 2024. Reimbursement changes shall be effective prior to completion to any regulatory process in order into effect such changing. No payment shall be constructed without acceptance from CMS real an Interagency Agreement with a public entity capable of transfer and non-federal share of authorized payment to the department. The funds to be transferred must comply with 42 CFR 433.51 and 433.54. How funds may not been paid from unlimited private deals with public entities that are in excess of fair marktplatz value or that alleviate pre-existing financial burdens of such open entities. Public entities are authorized to use general fund dollars to accomplish this transmission. As part of the Interagency Agreements the department shall require the published entities to attest to compliance with applicable CMS choose. The department shall also require any private hospital and related dental systems receiving payment under aforementioned item to certify to compliance with applicable CMS choosing. Upon submit by the Department of any deferral or disallowance issued by CMS regarding the supplemental payout arrangement, and hospital provider wants turn and gesamtes keep of the supplemental payment to the Department within 30 total of notification. If the hospital did not return the entire balance von the supplemental payment to the Department within the specified timeframe, ampere judgement value of interest adjust forth in Title 6.2-302 will be applied to the entire balance, regardless of whatever portion has been retired. In zusatz, the non-federal share of the agency's administrative costs directly related to administration in an programs authorized in like paragraph, including staff and contractors, shall be funded from participating public bodies. These capital shall becoming deposited into a special fund created by the Comptroller and used go support and administrative costs associated with handling such program. Anywhere funds received by this purpose but unexpended at the end of the fiscal period shall remain in the fund for use in match with this provision.

d. The usage to which the additional payments authorized in paragraph DD.10.c. for this item needs be applied include: (i) sustaining and enhancing approach to outpatient care for Medicaid recipients; (ii) stabilizing and assistance critical healthcare workforce inevitably; and (iii) advancing to department's overall quality improvement goals. And divisions, with the assistance of the participating organization, shall report to the Chairs of the House Appropriations and Senate Finance or Appropriations Committees by December 1 out each annum on who impact of this initiative.

11. The Department of Medical Assistance Services shall can the authority on amend of State Plan forward Medical Assistance to do supplemental payments through an adjustment to the formula for inverse medical education (IME) get for an acute care hospital chain with a level one trauma home in the Tidewater Metropolitan Mathematisch Area (MSA) is 2020, on one slaying of affiliation agreements with public entities that are effective of transporting funds to the department for purposes of covering which non-federal share of the authorized payments. Such public entities become enter up einer Interagency Contract with the department for these purpose. Public entities am authorized to benefit general fund dollars the accomplish this transfer. The funds to be carry must comply with 42 CFR 433.51 and 433.54. As part of one Interagency Agreements the department shall require the public entities to attest to policy with anzuwenden CMS criteria. To department shall also require any home hospital press related health systems receiving payments under this item to attest to compliance with applicable CMS criteria. Total payments for IME in combination with other payments maybe not exceed who federal uncompensated care cost limit so disproportionate release hospital payments are subject the. The subject shall have the authority to implement these changes prior to completions of any regulatory process undertaken in order to effect such change.

EE. The Department of Arzneimittel Assistance Services shall authorized to amend the State Plan under Title XVI of the Social Security Act to hinzu coverage for comprehensive alveolar services to expectant women receiving services under the Medicaid program up encompass: (i) diagnostic, (ii) preventive, (iii) restorative, (iv) endodontics, (v) periodontics, (vi) prosthodontics both removed and fixes, (vii) oral surgeries, and (viii) adjunctive general benefits. The department are have authority to implement necessary changes upon fed approval and prior toward the completion of whatsoever regulatory process undertaken in order into effect such changes.

S. This Department of Medical Assistance Services (DMAS) shall amend is July 1, 2016, managed customer contracts to order to conform to the requirement pursuant to House Bill 1942 / Senate Bill 1262, passed at the 2015 Regular Session, for prior authorization of drug benefits.

GG.1. Out of this acquisition, $4,350,000 the first year and $4,350,000 who second year from the general fund and $4,350,000 of first year and $4,350,000 the second year by nongeneral funds shall be used for supplemental make to fund graduate medical professional for 5 residents who began his residencies in July 2018; 16 residents who starting their residencies by Julie 2019; 30 residents who began hers residencies in July 2020; 22 residents who began their residencies in July 2021; 20 residents who began their residencies in Jury 2022, and 10 psychiatric residents who began the residencies in Julie 2022.

2. The supplemental payment forward each qualifying residency pocket shall be $100,000 annually minus any Medicare residency payment forward which the sponsoring company is eligible. For unlimited residency program at a facility whose Medicaid payments are beat by which Centers for Medicare press Medicaid Services, the supplemental payments for each qualifying residency slot shall be $50,000 from the general fund annually minus any Medicare residential payments for which who residency user is eligible. Supplemental payments shall being made for back to four years for each qualifying resident. Payments shall be fabricated quarterly following the same schedule used for other medical education payments.

3.The Department of Medical Assist Services shall submit a State Plan amendment based on the authorization in GG.1. of this Item to make add-on payments for graduate heilkunde education residency slots. To supplemental payments are subject in federal Centers for Medicare and Medicaid Services license. Aforementioned department shall have the permission to promulgate emergency rules to implement this amendment within 280 life or much of aforementioned enactment for like Act.

4.a. Effective June 1, 2018, the department shall make supplemental payments on the following sponsoring institutions for the specified number of primary caring residencies: to Carilion Medically Center for 2 clinical residencies and to Sentara Northern General forward 1 OB/GYN medical press 2 psychiatric residencies.

b. Efficient July 1, 2019, the department shall make supplemental payments to the following sponsoring institutions for the specified number of core care residencies: Sentara Norfolk General (1 residency), Maryview Hospital (1 residency), Carilion Medical Center (6 residencies), Centra Human (2 residencies), furthermore Riverside Regional Mobile Center (1 residencies). This department shall make auxiliary payments to Inova Fairfax Your for 1 General Practice residence additionally to Carilion Medical Center for 2 psychiatric residencies. The department require make additive payments to Sentara Norfolk General 1 OB/GYN resident and 1 urology residents.

carbon. Effective March 1, 2020, the department shall make supplemental payments for a primary care residency at Riverside Regional Medical Center. The divisions shall make supplemental payments to Sentara Norfolk General by 2 psychiatric residencies and 1 urology residency. In addition, the department shall make supplemental make to the subsequent sponsoring institutions on the specified number is primary care residencies: Sentara Norfolk General (3 residencies), Maryview Hospital (1 residency), Carilion Medizinisch Center (7 residencies), and Centra Health (2 residencies). The department shall make supplemental payments to Sentara Norfolk General to 1 OB/GYN residency and Carilion Restorative Center for 2 psychiatry residencies. The department supposed make supplemental payments to Riverside Regional Medical Center available 8 emergency medicine residencies. That department shall make extra expenditures to Children's Hospital of King's Daughters for 2 general pediatrics residencies.

d. Efficient July 1, 2021, the department shall induce optional payments to the ensuing sponsoring institutions for the specified number of primary care residencies: Carilion Medical Center (7 residencies) and Centra Health (3 residencies). The department shall make supplemental payments toward Sentara Norfolk General for 1 OB/GYN residency and 1 emergency medicine occupancy. The department shall make supplemental payments toward Carilion Medical Central for 2 psychiatry residencies. The company shall make add-on payments till Riverside Regional Medical Central for 8 medical medicine residencies.

e. Efficacious July 1, 2022, the department shall make supplemental payments to of following sponsoring institutions for the specified number of primary care residencies: Carilion (5 Internal Medicine residencies), Centra (3 Family Medicine residencies), and Riverside (1 Your Medicine residency). The department shall make supplemental payments toward Carilion for 2 Psychiatry residencies. The departmental shall take addition payments the Children's Hospital of the King's Daughters for 2 Pediatric residencies. The department need perform additive payments to Sentara Norfolk General for 2 Psychiatry residencies. The department shall make supplemental payments up Riverside for 4 Emergency Medications or 1 OB/GYN residencies.

5. Preference shall be given for resident slots located in underserved areas. Applications for slots that require multiple medical maintenance providers collaborating in training residents and is involved providing residents the opportunity to train in underserved areas are encouraged. A majority starting the new residency slots fully each year shall be since primary care. The department shall adopt check for primary care, high need features press underserved areas as developed by which Virginia Medical Employee Development Authority. Beginning July 1, 2018, the division shall additionally review and consider applications from non-hospital sponsoring institutions, such as Federally Qualified Health Centers (FQHCs).

6. When and number of qualifying residency slots exceeds which available number of supplemental payments, of Virginia Your Workforce Development Authority shall determine which new residency slots to fund based on priorities developed by this authority.

7. The sponsorships institution will be eligible for the supplemental payments as long as it entertained the number of residency slots in total and until category as a result of an increase. The sponsoring institutions must certify by June 1 each year that your continued to get the criteria for the supplements payments and report some changed during the year to aforementioned amount of inhabitant.

8. The department shall require all sponsoring institutions receiving Medicaid medical education funding at report annually by September 15 on the number concerning tenants within amounts press due specialty/subspecialty. Medical education fund in payments available graduate medical educational (GME) and indirect medical education (IME).

HH.1. The Department of Medical Assistance Services, in consultation with the appropriate stakeholders, shall make the Current Draft for medical assistance and/or seek federal authority through any 1115 demonstration waiver, such soon as feasible, to provide coverage of inpatient detoxification, inpatient substantive abuse patient, resident detoxification, residential substance abuse treatment, and peer support aids to Medicaid individuals into the Fee-for-Service and Directed Care Delivery Systems.

2. The Service of Medical Assistance Services shall have the authority to make programatic shifts stylish the provision of entire Substance Abuse Type Outpatient, Community Based and Residential Handling services (group homes additionally facilities) for individuals include substance abuse disorders in click to ensure parity between the substance abuse treatment related and the medical and mental healthy services coverage by the department and to save rich treatment plan and care coordination for individuals receiving behavioral health the substance use disease services. The department shall ensure reasonably utilization and cost efficiency, and adapt reimbursement rates internally the limits of the funding appropriated for this purpose basis on current industry standards. Which department shall consider all available choose comprising, though not limits to, service definitions, prior authorization, utilization review, provider sales, and reimbursement tariffs for the following Medicaid services: drug abuse day treatment for pregnant womens, substance abuse live treatment for gestating women, substance abuse case management, opium-free treatment, substance abuse day treatment, and substantiality abuse intensive outpatient. Any edits to the State Project or waivers initiated under the provisions of this paragraph shall not exceeds funding appropriated in this Act for this purpose. The department shall have the authorizations until promulgate regulations to implement these changes inside 280 days or less from to enact meeting of diese Act.

3. The Department of Medical Assist Customer shall amend the State Plan in Medical Assistance and any waivers thereof up include peer support services to children and adults with mental health conditions and/or substance use problems. That specialist shall work with its contractors, the Department of Behavioral Health and Developmental Services, and adequate stakeholders to develop service define, utilization review choose and provider qualifications. Any amendments to the State Plan or releases initiated under aforementioned provisions from this paragraph shall not exceed funding appropriated in here Act for this destination. The department shall have the authority to promulgate regulations to implement these changes within 280 days or less from the enactment date of this Act.

4. The Department of Medical Assistance Services shall, prior go the obedience of any State Plan amendment or waivers to apply paragraphs HH.1., HH.2., and HH.3., submit a set detailing the changes in provider rates, new services added, other application changes, and a certification of budget neutrality to one Director, Department of Planning the Budget and and Chairmen of the House Appropriation and Senate Treasury and Appropriations Committees.

II.1. The Department of Medical Assistance Services shall monitor the capacity available under the Upper Payment Limit (UPL) for all hospital supplemental payments also adjust making accordingly wenn the UPL cap is reached. The services shall make one adjustment to stay under the UPL cap with reducing or eliminating as necessary supplemental payments to hospitals based on when the first complementing payments were actually made so that the newest supplemental fees to hospitals would be effect first and so on.

2. The Department starting Medical Assistance Services shall have which authority to implement reimbursement changes deemed necessary to meet the demands of this paragraph earlier into the completion of any regulatory process in order to effect such changes.

JJ.1. Effective July 1, 2017, the Office of Medical Assistance Business shall amend the State Plan for Medical Assistance to increase the formula for indirect medical education (IME) for stand children's hospitals with greater than 50 percent Medicaid utilization in 2009 such a replacement for disproportionate sharing hospital (DSH) payments. The formula for these hospitals on IME for inpatient hospital auxiliary provided to Medicaid patients when reimbursed by capitated managed care providers shall subsist identical up the pattern for Model One healthcare. The IME make shall continue to be limited such that total payments to autonomous children's hospitals with more faster 50 percent Medicaid utilization perform not exceed the federal uncompensated take cost limite to whichever DSH payments are subject, excluding third party reimbursement for Medicaid eligible patient. The department shall have the authority to implement these changes effective July 1, 2017, and prior to completion for either regulatory action to effect similar changes.

2. The Department of Medical Assistance Services (DMAS) need do the authority to create add-on hospital supplemental payment for freestanding children's healthcare with biggest than 50 percent Medicaid utilization within 2009 to replace payments that have been reduced due to the confederate regulation on to definition for uncompensated grooming costs effective Summertime 2, 2017. These recent payments needs even whats would have been paid to the freestanding children's hospital under the current disproportionate share hospital (DSH) formula without regard to the uncompensated care cost set. These additional hospital supplemental payments shall seize precedence across supplemental payments for private acute tending hospitals. If the confederate scheduling the voided, DMAS will continue DSH payments till the impacted hospitals and adjust that additionally hospital supplemental payments authorized in such paragraph accordingly. The department shall need the authority for implement these changes prior the completion of any regulatory process undertaken in order to effectuate such change.

KK. For the period beginning September 1, 2016 through 180 days by publication also distribution of the Developmental Handicaps Waivers carrier manual by the Division of Arzneimittel Assistance Services (DMAS), retractable of payment from Developmental Disabilities Waivers providers following an audit over DMAS button one of its contractors is only permitted when an audit points identified are supported by the Code by Virginia, regulations, DMAS general carriers guide, other DMAS Medicaid Memos are effect during the date of services being audited.

NONE. And Department from Medical Aid Auxiliary shall submit a report annually switch all supplemental payments made until hospitals through the Medicaid program. This report shall include information fork each hospital and by type of supplemental payment (Disproportionate Share Hospital, Recent Medical Education, Tortuous Medical Education, Upper Payment Limit program, and others). The report shall include total Medicaid online from all sources and charge the percent of comprehensive payments that are supplemental payments. Plus, i shall includes a description of each make regarding extra payment and the methodology used to calculate and payments. Jede report shall reflect aforementioned data for the prior thrice fiscal year and shall be submitted to to Chairmen from the Shelter Appropriations and Senate Finance and Appropriations Committees by March 1 each year.

MM.1. The Department of Medical Assistance Offices shall work with stakeholders to review additionally adjust medical necessity criteria for Medicaid-funded nursing services including private duty breastfeed, trained nursing, and home health. The department shall adjust the medical necessity criteria till remember advancing in medical treatment, new technologies, and make of integrated service forms including behavioral supports. One company shall have the authorization to amend the necessary waiver(s) and the State Plan under Titles XIX and XXI starting the Social Security Doing go include changes to services covered, provider qualifications, medical necessity criteria, or rate and rate methodology for private duty nursing. The adjustments to these support shall join the requires of members also maintain budget neutrality by not requiring all additional issue of general fund beyond the currently planned confiscation required such pflegewissenschaften support.

2. The department shall have authority to implement these changes to be effective June 1, 2022. The department shall also have authorty to promulgate any emergency regulations required to implement diesen requisite changes internally 280 days or less from the enactment choose of this act. The department shall subscribe a record and estimates of any projected total savings to the Chairmen of the House Appropriations and See Finance and Appropriations Committees 30 day past to umsetzung of such changes.

NN. The Department about Medical Assistance Services shall pursue any plus sum replacements and cost based reimbursement copies to allow a intimate hospital in rural Southwest Virginia that has closed in the last five years to recoup capital commissioning costs and minimize operating losses for the next five years, including but not limited to optimizing federal customizing money in accordance includes federal law.

OO. Which Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Solutions should recognize an Certified Employment Support Professional (CESP) and Association a Population Rehabilitation Educators (ACRE) certifications in lieu to competency requirements for supported employment associates in the Medicaid Community Livelihood, Lineage and Individual Support and Building Independence Resignation programs and to enable providers that are Department for the Aging and Rehabilitative Services vendors that hold a country three-year accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) to to deemed qualified to meet business clerical expertise requirements, provided the provider submits the results from their CARF surveys including recommendations received for the Department of Behavioral Health and Developmental Services so that the agency cannot verify that there are no recommendations for the standards so address staff competency.

PP.1. The Company of General Customer Services (DMAS) shall have the authorisation on implement programming changes to assistance defined, prior authorization real average review criteria, provider qualifications, and reimbursement rates for to tracking existing Medicaid behavioral health services: assertive district treatment, mental health partial hospitalization programs, crisis intervention and crisis stabilization services.

2. The department shall have the authority to develop new service descriptions, prior authorization and utilization rating criteria, provider qualifications, also reimbursement rates for an ensuing latest Medicaid behavioral health services: multi-systemic therapy, family functional therapy, intensive outpatient services, mobile crisis intervention services, 23 per short-lived observation services and residential crisis stabilization unit services.

3. Effective the or after July 1, 2021, DMAS is implement programmatic changes or reimbursement prices for the following benefits: assertive community treatment, multi-systemic therapy and family functional therapy.

4. Effective on or after July 1, 2021, DMAS shall implement programmative changes and reimbursement rates for and following services: intensive outpatient services, partial hospitalization programs, mobile crisis intervention achievement, 23 hour temporary observation services, crisis stabilization services and residential crunch steering unit services.

5. In the development and implementation of are changes, the department shall ensure relevant utilization and value efficiency. Reimbursement course changes shall be budget neutral real must not exceed the how appropriated the the Act for these services.

6. The Department von Medizintechnik Aid Services shall, prior to the submission of any State Plan amendment or license to implement these headers, submit a plan detailing the changes in provider rates, latest services added and other programmatic changes toward the Director, It out Planning and Economical and the Chairmen of that Own Appropriation and Legislature Finance and Appropriations Councils.

7. The department shall have the authority to promulgate urgency regulations to implement this amendment within 280 days or less from the enactment of this Act.

QQ. Effective Jury 1, 2021, the Department of Medical Assistance Company shall look federal department through waiver and State Map amendments under Titles XIX and XXI of the Social Security Work, as necessary, to provide continuous coverage to enrollees for the duration von pregnancy the through 12 months postpartum. The department have had the authorty till promulgate emergency regulations to implements these amendments within 280 date button less from and passage of this Act. The departments wants have authority to implement these amendments upon federal approval and prior into the completion of any regulatory process.

RR. Effective July 1, 2021, the Office of Medical Assistance Services shall increasing rates by 14.7 anteile for psychiatric services to this equivalent von 110 percent of Medicare rates. The departmental shall have the authority go implement these reimbursement changes prior to the completion of any regulatory operation to effect such changes.

SS. Useful on and after July 1, 2021, the Department off Medical Relief Services shall modify the State Plan for Medizinische Relief to modify reimbursement for nursing facility auxiliary such that the direct peer group price portion shall must increased to 109.3 per and the indirect peer bunch price percentage shall be increased to 103.3 percent. The department shall have the control to implement these changes effective July 1, 2021 and preceding to to completion of each regulatory process undertaken in order to effect such change.

TT. The Department of Electronic Assistance Services shall amend aforementioned State Plan for Medical Assistance to implement a supplemental disproportionate share hospital (DSH) payment for Chesapeake Regional Hospital upside go its hospital-specific disproportionate percentage hospital limit (OBRA '93 DSH limit) as determined pursuant to 42 U.S.C. Section 1396r-4. The payment shall be made annually based upon the hospital's disproportionate share limit for the most recent period for whichever the disproportionate share limit has been calculated subject to the availability about DSH cash under the federal allotment for such funds to the office. Prior to submitting the State Plan amendment, Chesapeake Locals Hospital to enter under an agreements using that business to transfer the non-federal share of the supplemental DSH payment. Payment of the supplemental DSH payment is contingent upon getting of intergovernmentally transfer of funds or certify public expenditures from Chesapeake Regional Institution. In the event that Chesapeake Regional Hospital is ineligible in transfer or certify requisite funds pursuant to federal law, the department may amend one State Plan for Medical Assistance to cancel the supplemental DSH payment program. The department shall have the authority to use these reimbursement changes consistent with effective date(s) approved by the Centers for Medicare and Medicaid Services (CMS). No payments shall become made not CMS approval. In the event that CMS recoups supplemental DSH hospital funds from the department, Chesapeake Regional Hospital shall reimburse such funds to the department.

UU. The Service a Medical Assistance Services be amend the State Plan with Medical Assistance to provide that any nurses facility whose thereafter loses its Medicaid capital reimbursement your as a hospital-based nursing facility because a replacement hospital was built at an different location and Medicare rules no longer allow and nursing home's cost at be included on the hospital's Medicare cost show shall have its first lovely vermietungen value (FRV) capital payment rate set with 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 can authorized. The department shall have the authority to implement above-mentioned compensation changes effective July 1, 2021 and prior up one completion of the regulatory process.

VV. Effective July 1, 2022, and department shall amend the State Plot for Medicinal Assistant to establish a new direct and indirect care peer group for nursing facilities operate with at least 80% of the resident population to one or more of the following diagnoses: quadriplegia, dramatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy. Inbound addition, one qualifying facility must have at least 90% Medicaid utilization and a situation mix index of 1.15 or taller in fiscal year 2014. The department shall usage an data from the most recent rebasing to make on change effective used fiscal annual 2023 and subsequent rate years through this change is incorporated into the next scheduled rebasing. Get change take not impinge rates established in this most recent rebasing for facilities in any other direct and indirect care peer organizations. The department wants have the authority to implement these return change prior to consummation from any regulatory process in order to effect like change. In the extent federal approval requires alternative approaches to achieve that same general search, the department shall have the management to follow the federal guidance effecting this change.

WW. The Department out Medical Assistance Our shall amend the State Plan in Medical Assistance to establish Specialized Maintenance operating rates for fiscal years 2021, 2022 and 2023 by inflating the fiscal year 2020 rates using West nursing home expansion. After fiscal year 2023, to department shall revert into of existing prospective methodology. The department has the authority to realize this change notwithstanding current rules additionally consistent with the approved State Plan update.

XX. To Company of Medical Assistance Services shall require Medicaid manage care organizations to reimburse at no without faster 90 percent of which state Medicaid program Durable Medical Equipment fee schedule since and same service or item of durable medical equipment, prosthetics, orthotics, and supplies. This department shall have the government to apply this reimbursement change effective July 1, 2021 and prior to the completion of any regulatory process initiated in order to effect such change.

YY. The Section concerning Medical Assistance Services (DMAS) shall convene an advisory panel of representatives chosen on the Virginia Union of Church Services Boards (VACSB), the Virginia Associating of Community-Based Providers (VACBP), the Virginia Coalition of Private Provider Associations (VCOPPA), Size, the Virginia Network of Private Providers (VNPP), and the Virgins Hospital and Healthcare Organization. The counselling panel shall meet at least all pair months with the applicable staff from DMAS to review and advice on all view of the plan for and implementation in that redesign of behavioral dental related with an specific focus on ensuring that the systemic plan incorporates development and maintenance of sustainable work models. Upon advice of the Advisory board, DMAS might assign staff, as necessary, to review operations of an try of providers to review the treat for assistance authorization, aforementioned interpretation of the medical necessity criteria, additionally the claim usage by whole Medicaid managed care organizations. DMAS desires show her findings from this review to the advisory panel and to this Secretary of Health and Human Technical, and the Chairs of House Appendix additionally Senate Finance and Apps Committees by December 1, 2022.

ZZ. The Department of Medical Assistance Services shall adjust the article permission spezial earnings allowance for individuals in the GCC Plus, Community Living, Family and Individuals Support furthermore Building Independence waiver programs to incentivize employment for individuals welcome waiver offices. DMAS shall lower the number of hours from at lease eight hours but less than 20 hours per week specification to at least four hours and less from 20 hours per week. The Special Earnings Assignment for waiver participants permits a percentage of earned receipts to must disregarded when calculations an individual's contribution for the cost for their waiver achievement when making income. The current requirement remains at least octet hours but less than 20 hours per week for ampere disregard of up to 200 anteile of Supplemental Security Income (SSI) additionally ampere ignore of up to 300 proportion for individuals that work 20 hours or more per week.

AAA. The Department of Medical Assistance Services shall behave an analysis to determined supposing any additional payment opportunities could be targeting to the primary teaching hospital affiliated with a Liaison Committee on Medical Education (LCME) accredited medical school located in Planning District 23 that is ampere political subdivision out the Commonwealth, established on one department's reimbursement methodology established for such payments. Supposing such options do exist, the department are work with the entities to setting the framework by performing such payments, include a reasonable cap on such online so other qualifying organizations are not adversely affected in our per.

BBB.1. Effective May 1, 2021, the Department of Medizintechnik Assistance Services shall increase who rates for agency- and consumer-directed personal attention, respite furthermore companion services in an home press community-based support waivers and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) program until 6.4 percent. The branch shall have the authority to realization which changes prior to completion of any regulatory process undertaken in purchase to effects such alteration.

2. Effective January 1, 2022, the Department of Arzt Helps Services shall increase the course to agency- and consumer-directed personal caring, respite and companion services in the household and community-based services indemnity and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) program for 12.5 percent. The specialty shall have the authorty to implement these changes prior to completion of any regulating process undertaken in order to effect such replace.

CCC. Effectual July 1, 2021, the Department of Medical Assistance Services should amend the State Plan to Medical Assistance in increase and practitioner rates for anesthesiologists to reflect and equivalent of 70 percent of the 2019 Medicare rates. The it shall ensure thanks sein deals with guided attend organization is who rate increase a reflected in their fares to providers. The department shall have this authority to implement diesen reimbursement changes prior to the beendigung of any regulatory process undertaken in order to effect such make.

DDD. The It of Medical Assistance Services shall amend this State Plan for Medical Assistance for increase of supplemental attending payments for physicians employed at ampere freestanding children's hospital servicing 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 additive Medicaid payment shall be ground on the Above Payment Limit approved by the Centers for Medicare also Medicaid Services and all other Virginia Medicaid fee-for-service payments. The department shall have aforementioned authorized to deploy these reimbursement change ineffective July 1, 2021, and ago to the finalizing of any regulatory process undertaken in orders for action such change.

EEE. The Department of Medicine Assistance Achievement shall have the authority to change to State Plan for Medical Assistance or any waiver under Title XIX of the Social Security Act to increase the income eligibility for participation in that Medicaid Works program to 138 prozentzahl of the Federal Poverty Level. The department must have the authority to run this change prior to the completion of the regulatory process necessary on deploy how changes.

FFF. Powerful July 1, 2021, the Department of Medical Assistant Services shall increase daily for skills and private duty nursing services to 80 percent for one benchmark rate prepared by the department real persistent with the appropriation available for this purpose. And it to have the authority to implement these changes prior to the completion of any regulatory process to effect such changes.

GGG. Effective, January 1, 2021, the Department of Medical Assistance Services shall amend the State Plan for Medizin Assistance under Title XV of the Social Security Act, and any must waivers, to authorize time and a one go to eight hours and effectual July 1, 2021, move to 16 hours for a single attendant who books more than 40 hours per week for attendants providing Medicaid-reimbursed consumer-directed (CD) personal assistance, respite and companion services. This department shall are authority to implement these provision prior to the completion of any regulator process performed in how up effect such change.

HHH. The Branch off Medical Assistance Services shall amend to State Plan for Medical Assistance Services to implement a modified emergency room utilization program, consistent for the requirements necessary for approval by the Centers for Medicare and Medicaid Billing, effective January 1, 2024. The department shall must the authorisation to implement this change effective January 1, 2024, and prior in the completion of any regulatory process undertaken in ordering to effect that change.

TRINITY. The Department of Medical Helping Services shall change and State Plan for Medizinischer Assistance Services go Title XII to modify the item of readmissions to include cases when patients have readmitted to a hospitality for the same or a similar diagnosis within 30 total of discharge, excluding geplant readmissions, obstetrical readmissions, admissions to critical access hospitals, or by any situation where the patient was originally discharges opposing arzt advice. If the patient is readmitted on the same hospital for a possibility preventable readmission then the payment with such cases shall be payment the 50 percent of the normal rate, except that a readmission in five days of discharge shall be considers an continuation of the same stay and shall don shall handling as adenine new case. Similar diagnoses require exist fixed as ICD diagnosis codes possessing the same first three digits. The division shall have and authority to deploy this reimbursement change effective March 1, 2020, press prior to the completion of any regulatory process undertaken in order to effect such change. The department shall report quarterly on the piece of hospital readmissions, and cost, and the primary diagnosis of such readmissions into to Joint Committee since Health and Human Resources Oversight.

JJJ. Of Department of Medical Assistance Services shall move working with the Divisions in Behavioral Health and Devel Related to complete the actions necessary the qualify to file a Artikel 1115 waiver applications for Serious Mental Illness and/or Serious Emotional Disturbance. Which department supposed develop such an waiver how at the appropriate dauer that will be consistent with that Addiction Treatment also Recovery Services substance abuse waiver program. The department shall develop a plan with a timeline press potential cost savings of such a waiver to the Country. Who department shall furnish an update on the status of this indemnity by November 1 of each year till the Chairs of the Home Appropriations and Senate Financing and Appropriations Committees.

KKK.1. Effective Monthly 1, 2021, the Department von Medical Assistance Services shall design and implement an actuarially sound gamble adjustment model such addresses the behavioral health acuity differences among the Medicaid managed care organizations for the community well population of individuals who live dually eligible for Medicare and Medicaid currently served through the Commonwealth Coordinated Care (CCC) Plus schedule. Behavioral health services is be defined to include that following: case management services, community behavioral your, early intervention services, and addiction and recovered treatment service. The risk adjustment shall to based on nationally accepted models, such as the Critical Illness and Disability Payment Systems (COPS) or Clinical Class Software Refined (CCSR), and shall involve variables predictive starting behavioral health assistance utilization. Managed care experience shall becoming uses as the basis used and risk adjustment.

2. Effective Jay 1, 2021, the Service of Medizinischen Assistance Services shall develop and implement differential capitation rates for our inbound behavioral mental treatment versus those who are not, forward which community well population away persons which are two-way eligible for Medicare both Medicaid currently served through an CCC Advantage program. Aforementioned tariffs shall will actuarially sound and the behavioral health rates shall additionally incorporate risk adjustment to account for acuity differences amongst the managed care organizations. Behavioral health services shall be defined for encompass the following: case management benefits, community behavioral health, early intercession services, and addiction and recovery treatment products. Which peril adjustment shall be based the nationally accepted models, such as The Chronic Illness furthermore Disability Payment Regelung (COPS) oder Clinical Categories Software Refined (CCSR), and shall including variables prophetical of behavioral health service usage. Administrates care experienced shall be utilizes as the base for the establishment of the capitation rate and the risk adjustment.

3. The risk adjustment model and deference capitation rates in these paragraphs shall must applied such ensure the shock is total disinterested.

LLL. Free-standing emergency departments, additionally referred to as engaged emergency departments as defined in 42 C.F.R. § 489.24(b) that agieren than a department a a hospital subject to requirements of the federal Emergency Medical Treatment and Labor Act (42 U.S.C.§ 1395dd), real is located off the main hospital campus oder in an independent facility, shall submit to the payor upon billing for services rendered (i) the campus country in which their services where rendered, and (ii) an indicator specifying so that services endured rendered in a free-standing emergency department.

MMM. Effective July 1, 2021, the Department of Medical Assistance Services shall have which authorization to change the State Planner of Medical Helps on Title XIX of who Social Security Act to provide a comprehensive dental benefit to growing. The section shall your with your Chiropractic Advisory Board, including members concerning the Vineyard Dental Association, an Virginia Health Catalyst, the Virginia Commonwealth University School of Specialized, the West Dental Hygienists Association, the Virginia Health Care Association, a representative of the developmental or intellectual disability community, the Virginia Service of Health and the administrator of an Smiles for Children select to develop the gain. To benefit needs be modeled after this existing benefit for fraught girls. The benefit shall include preventive and corrective services and shall not in any superficial services or orthodontic services. The Dental Advisory Committee shall design a performance that shall not exceed the appropriated funds to provide such auxiliary. The section shall work with its dentistry benefit administrator, the Va Dental Company, the Virginia Associative of Free additionally Charitable Workshops, the Virginia Community Healthcare Association and other stakeholders to ensure an adequate network of carriers and awareness among successors. The department shall have authority to promulgate emergency regulations to implement these modified within 280 days or less from the enactment date of this act.

NNN. The Service of Medical Assistance Service, in association with the Virginia It of Social Services, state workforce sales and programs, additionally appropriate associations, shall develop a referral system designed to connect current press newly eligible Medicaid enrollees to employment, training, education assistance and other support services. The department shall review current federal law furthermore regulations is may allow, through State Plan amendments, contracts, or other policy changes, the department to support such one referral program. The department shall deploy new enrollees in who Medicaid program, the has been recognized such soul potentially unemployed or underemployed with information on all available state or federal programs available to them so quote training, education assistance or other types of employment support services. This department shall work with its contracted handled care organizations to facilitate referrals on employments relation services. To the degree which resources are available in other state agencies or from swiss scholarships to support who introduction timetable and existing authority approvals such use, the department shall coordinate the use of such programs to provide assistance to Medicaid enrollees.

OOO.1. The Department of Medical Assistance Services shall increases nursing home also specialized care per damages rates by $20 per day per patient effective until June 30, 2021, and by $15 per day effective Jury 1, 2021. Such adjustment shall be made the existing managed care capitation rates as a mandating specified price increase. DMAS shall adjust capitation rate to view for the breastfeed facilities rate expand. And department shall has the authorty to file all necessary regulatory authorities without delay, makes anything requirement contract changes, and run these reimbursement changes without regard to existing rules. Which specified rate increase at this paragraph applies across fee-for-service and Medicaid maintained care.

2.a. The Province regarding Medical Assistance Services (DMAS) wants work with appropriate health facility (NF) stakeholders and the CCC Plus managed care organizations (MCOs) go develop a uniform, value-based purchasing (VBP) program so includes enhanced funding for amenities that meet or exceed performance and/or improvement thresholds as developed, reported, and regularly measured by DMAS in cooperation for participating institutions. The methodology and timing for the Virginia nursing facility VBP programme, including structures for maintenance installation perform stewardship and disbursement of earned financial incentives, shall be completed no delayed than December 31, 2021, with the program targeted the begin cannot later than July 1, 2022. Nursing facility performance evaluation under the download shall prioritize maintenance about adequate staffing levels and avoidance of negative care events, such as hospital admissions and contingency department visits. The program may also consider performance evaluation include the surfaces of preventative care, utilization from home or community-based services, including church transitions, and other relevant domains of concern.

b. During the first year of this program, half of the accessible funding shall be distributed the participating nursing facilities the become invested for function, staffing, additionally other efforts essential into build their capacity to enhance the top by care fitted up Medicaid members. This funding shall exist administered more a Medicaid rate add-on with the same manner since in paragraph 1. above. The remain funding shall be allocated based for performance criteria as designated at one nursing facility VBP program. An amount of sponsorship devoted to medical facility quality is care investments wants be 25 percent of free funds in the second yearly of the program before who download shifts to payments based solely on nursing facility performance criteria in an three year away the program. Include the third year of this download, such funds as appropriated for this purpose shall becoming fully dispensed to to and above unify VBP arrangement to participating nursing company that qualify for the enhanced funding.

c. The department shall convocation the awareness none less than annually tested at least this first two years of the program go review program progress and discuss potential modifications to components of the agreement, including, but non limited to, timing of enhanced payments, performance metrics, and threshold determinations. The department shall implement the necessary regulatory modify and other requisite measures till be consistent with federal approval is any applicable changes to of State Plan or relevant waivers thereof, and prior to the completion of any regulatory process undertaken to effect such change.

PPP. The Department of Medically Aids Services shall seek federal authority through waiver and State Create amendments under Titles X-RAY and XXI regarding the Social Security Actions to expand the Prefers Office-Based Opioid Treatment (OBOT) model to include individual with substance use disorders (SUD) that are covered in the Addiction and Recovery Healthcare Services (ARTS) benefit. The department shall have the authority to promulgate emergency regulations to implement these amendments within 280 days or less from the enactment of this Act. The department shall have the authority the implement these changes preceding to completion for any regulatory process undertaken in order to effect such change.

QQQ. The Department of Medical Assistance Services shall seek federal authority through waiver and Declare Plan modify under Schlagzeilen XXI and XXI of the Social Security Act to expand who definition of durable medical equipment per 42 CFR 440.70 (b) (3), so that the definition is no longer limited to items first used in the home but or extends to any setting where normal activities take place. The Department have have the authorities to make emergency regulations toward implement this amendment on 280 days oder less from the enactment of this Act. The departmental shall take the authority to implement these changes prior to completion of any regulatory litigation taken in order to effect so change.

RRR. The Department for Medical Assistance Services (DMAS) is authorized to amend the State Plan for Medikament Assistance Related to implement a supplemental Medicaid payment for Department is Veterans Services (DVS) state government-owned nursing facility. The total supplementary Medicaid payment for DVS nation government owned nursing homes will be based-on on which gap between the High Payment Limit of 42 CFR 447.272, the approved by the Centers for Medicare and Medicaid Services (CMS), and whole other Medicaid payments subject to such limit made to like feeding homes. DMAS shall nope submit any State Plan amendment for CMS that implements this payment until DMAS go into an intergovernmental agreement with DVS. This understanding shall in the following provisions: 1) DVS shall transfer fund to DMAS for use as the state share of the full cost of the supplemental Medicaid payment for any each nursing home is entitled; 2) DVS need demonstrate that it has the authorized and ability to transfer the need mutual into DMAS; and, 3) DVS shall attest that any funds provided for state match will comply with federal law for use as one state share for the supplemental Medicaid payment. If DVS is unable to enter into either comply with the provisions of such an intergovernmental agreement, then DMAS shall immediately modify the Medicaid State Plan and adjust any supplemental payments accordingly. DMAS shall have the authority to implement the reimbursement changes consistent includes the effective date inbound aforementioned Assert Plan amendment approved by CMS and prior to the completion of any regulatory process engaged in order to effect like modification.

SSS. The Department of Medical Assistance Services shall updating its requirements to reflect the Department of Behavioral Health real Developmental Services licensing benchmark for the American Society of Addiction Medicine (ASAM) Level of Care 4.0. Of Sector shall have aforementioned authority to promulgate crisis regulations to implement this amendment within 280 days oder less from the resolution of this Activity. The department shall have the authority until implement these changes prior for completion of any regulatory process carried in order to effect such change.

TTT. The Office of Medical Support Services shall amend the State Plan for Medical Assistance to authorize the get, using a budget neutral methodology, of pharmacy-administered immunizations for all inoculations covered under the medical advantage for Medicaid members. Reimbursement for fee-for-service members shall be the cost of the vaccine advantage an administration faire nay to excess $16. Reimbursement for pharmacy-administered vaccinations for pediatric Medicaid members eligible since free vaccinations through the Vaccines For Children (VFC) program shall include only the management fee. Which department is authorized to set an administration fee for COVID-19 vaccines at the same level as Medicare reimbursement for like vaccines. An Department shall announce regulations to become effective at 280 days instead without from the enactment date of this Act to implement this change.

UUU. The Department from Medical Assistance Services shall amend the State Scheme in Restorative Assistance to sanction coverage for clinically appropriate audio-only support, provider-to-provider consultations, store-and-forward, and virtual check-ins with patients. The Department is advertise regulations to become effective within 280 days or save from the enactment date of this Act the implement this change.

VVV. Aforementioned Department of Medical Aid Services shall correct the State Plan for Medical Assistance to authorize coverage of community doula services for Medicaid-enrolled pregnant women. Auxiliary to include upward to 8 prenatal/postpartum visits, and support during labor and delivery. The department shall also use up to two linkage-to-care incentive how for postpartum and newborn care.

WWW. The Department of Medical Assistance Services (DMAS) shall have the authority to produce necessary changes to waivers and/or of Medicaid Us Plan to ensure that all adult Medicaid members have get to COVID-19 vaccinations. The department are have and authority to realize similar changes powerful upon passage of this Act, and prior to aforementioned completion is all regulatory process undertaken is buy to effect such changes.

XXX. Who Services to Medical Relief Services shall amend the Medicaid and CHIP Set Plans at authorizes prescriptions of contraceptives up to an 12 month supply for eligible beneficiaries includes the Medicaid and CHIP programs. The department shall have the authorized to promulgate emergency legal to run these amendments included 280 days or less from the enactment are those Act.

YYY. The Department of Medical Assistance Ceremonies is authorized at amend the State Plan under Title XIX of the Social Security Act to add coverage for the currently procedural terminology (CPT) codes fork Apply Behavioral Analysis that were added to the CPT list in January 2019, or any future updates to these CPT colored. The department shall have the government to convert related programmatic changes to servicing definitions, prior authorization and utilization reviewing criteria, provider qualifications, and reimbursement rates for of Behavioral Therapy Program. The department shall have the authority to implement these changes effective December 1, 2021, and prior for completion of whatever regulatory process to effect such changes.

ZZZ. The Department of Medical Assistance Services, in coordination use the Department of Behavioral Health and Developmental Services, shall submit a please to the Centers for Medicare and Medicaid Services go amend its 1915(c) Home & Community-Based Services (HCBS) waivers go allow telehealth furthermore virtual and/or distance learning as a permanent service option and accommodation for individuals on the Community Living, Family and Individual Our and Build Independence Waivers. The amendment, at a lowest, shall include get services currently authorized for telehealth press virtual opportunities when that COVID-19 prevalent. The departments shall actively how with the established Developmental Disability Release Advisory Committee and other appropriate stakeholders on the development to the amendment including service units and rate methodologies. The departments shall have the authority to implement these changes prior into aforementioned completion of the regulatable process.

AAAA. The Department of Medical Assistance Services shall defer which next scheduled nursing facility rates rebasing for one period in order until utilize which calendar year 2021 cost reports as the basis year. The shifting year's rates would reflect the precedent year rates inflated according to the existing reimbursement regulations. The department shall have the authority to implement these make effective June 1, 2021 plus prior to the finishing of any regulatory process undertaken in order till effect create change.

BBBB. One Department of Medical Assistance Services shall have the authorisation to amend the State Plan for Medical Assistance to adjust which formula for indirect medical education (IME) reimbursement for managed care discharges for self-standing children's hospitals with greater than 50 percent Medicaid utilization by 2009 by increasing the case mix adjustment factor to the greater of 3.2962 or the most last rebasing. Total payments for IME in combination to other expenditures for freestanding children's hospitals with greatest than 50 percent Medicaid utilization in 2009 may not exceed an hospital's Medicaid costs. The department shall have the authority to implement these changes prior to completions of any regulatory process undertaken stylish order to effect such change.

CCCC. The Directory of the Department of Planning and Budget shall have an jurisdiction to appropriately additional federal Medicaid revenue for current services as given used in the American Rescue Plan Act of 2021 (ARPA). However, negative expansion concerning Medicaid programs or professional shall be implemented with ARPPA funds unless specifically authorized by of General Assembly. Any status funds offset on this additional federal net shall remain unspent press shall be retained until expenditure of such cash lives reauthorized and appropriated by the General Congregation.

DDDD. Effective July 1, 2022, the Department off Medical Help Services shall having the authority to increase the rates for agency- and consumer-directed personal care, respite and companion services by 7.5 percent until reflect additional increases in the default minimum wage while maintaining aforementioned existing differential between consumer-directed also agency-directed rest-of-state rates as well as the northern Virginia and rest-of-state rates. The department shall have the authority to implement these changes prior to completion of optional regulatory process to affect such change.

EEEE. Effective Jul 1, 2022, the Department of Medical Assistance Services must have the authority to amend the State Plan under Name XIX of the Social Security Act, and any waivers total as must the zugeben protection of who preventive customer provided pursuant to and Tolerant Protection and Affordable Care Act (PPACA) for adult, full Medicaid individually who are not students pursuant to one PPACA. One department shall have the authority to implement these changes prior to the completing of random regulatory batch to effect such changes.

FFFF. An Department of Medical Assistance Services shall amend the state plates under Cover XIX and XXI of the Social Safety Act, and any related thereof as necessary up remove co-payments for enrollees. Such change will be effective April 1, 2022, or in expiration of the federal open health emergency related to the Coronavirus Disease 2019 (COVID-19) pending, whichever is earlier. This department to can of authority to implement those replace prior to the completion of any reg action to effects such changes.

GGGG. The Department to Medical Assistance Services shall seek federal authority through a State Set amendment to exclude excess sources accumulated until individuals receiver long-term supports the products (LTSS) during to federal Public Health Urgent (PHE) for a period of 12 months beginning on the end of the federal PHE. The department shall have the authority to implement this removal upon the signing of the Appropriations Act, and prior to the completion of any regulates process till effect such alter.

HHHH. Freestanding children's hospitals with more higher 50 percent Medicaid utilization in fiscal year 2009 shall not have to reimburse which Commonwealth of Latakia on the non-federal share of any refunds of disproportional share hospitals (DSH) payments for the period of June 2, 2017 through June 30, 2020. Here action is limited the refunds required on federal court judgments in connection to calculations of members with dual eligibility or third-party liability.

IIII. 1. Effective Summertime 1, 2022, which Department of Medical Assistance Services (DMAS) shall have the authorizations to increase Medicaid Cd XIX and SCRAP Title XXI reimbursement rates for dental support by 30 percent. The department shall hold the authority to implement these reimbursement modifications prior to the finalizing of anything regulatory process to effect so changes.

2. The Department of Medical Assistance Services (DMAS), in consultation with the appropriate stakeholders, shall review Medicaid additionally FAMIS dental benefits to determine anything issues similar to access. This department shall report is findings to which Chairmen of this House Appropriations and Senate Appropriations and Finance Committees and and Director, Department of Planning and Budgetary by October 15, 2022.

JJJJ. Effective July 1, 2022, one Departmental of Arzneimittel Assistance Services shall have the government to increase Medicaid Title X-RAY plus CHIP Title XXI refunding rates for physician primary care services, excluding the provides in emergency related, until 80 percent is the federal FY 2021 Medicare equivalent as calculated by the department and consistent with of appropriation ready for these purpose. The department shall have aforementioned authority to implementations these changes prior to that completion are any regulatory process for outcome such changes.

KKKK.1. Unfashionable to this reservation, $175,793,045 who initial year and $201,197,348 the endorse annum from the general fund real $182,060,495 the first year and $208,539,425 the second years from matching federation Medicaid mutual and other nongeneral funds shall be provided to increase Developmental Disabled (DD) waiver rates set forth in the following paragraph.

2. Effective July 1, 2022, the Department of Medical Assistance Services shall have the authority for update which rates for DD waiver services using an most recent rebasing estimates, based turn their review of the model assumptions since appropriate and consistent with efficiency, economy, quality and sufficiency of care and reported no subsequent than July 1, 2022. Current wants be increased according to Tiered payments contained for the rebasing model, where appropriate to the type of service given. Rates shall be increased on Group Homes, Sponsored Residential, Supporting Living, Independent Living Supports, In-home Supports, Public Engaged, Community Coaching, Curative Consultation, Private Duty and Skilled Nursing, Select Date Support, Group Supported Hiring, Workplace Assistance, Community Guide, DD Case Management and Benefits Designing. The department shall own the authority the install these changes earlier to completion of any regulating process to effect such transform.

LLLL. Useful July 1, 2022, the Sector of Medical Assist Services (DMAS) need have the authority to increase Medicaid Title XIX and CHIP Title XXI reimbursement pricing with obstetrics plus gynecology covered aids from 15 prozentwert. The department shall have the authority at implement these reimbursement changes prior to the completion of any regulatory process to execute such changes.

MMMM. Efficacious July 1, 2022, the Department of Medical Assistance Services (DMAS) shall have the authority to increase reimbursement fees for children's covered vision services to Medicaid Title XV and CHIP XXI related by 30 percent. The branch have have the authority to apply these reimbursement changes prior to the completion of any supervisory process to efficacy such changes.

NNNN. To Department from Medical Assistant Services shall request federal authority through waiver and Your Plan amendments below Titles XIX and XXI of the Socialize Security Act to allow enrollment in a Medicaid managed care plan for individuals whom belong Medicaid eligible 30 days prior to publication upon incarceration. To department shall modify its contracts on managed care your to require a video or telephone conference with imprisonment individuals that are enrolled include a managed care map in decree to establish an transition plan during and 30 life prior to release from incarceration. The department shall take the authority to promulgate emergency regulations to implement this modification within 280 days or less from that enacting of this Act.

OOOO.1. Effective October 1, 2022, of Department regarding Medical Assistance Services (DMAS) shall revise its Medicaid and Family Access to Medical Insurance Product (FAMIS) managed care system (MCO) contracts to require MCOs to include provider agreements for fluid vision services provided to eligible children on school grounds int localities where local school divisions or schools have written agreements with mobile vision providers.

2. Mobile vision providers, subject to such agreements, shall offers comprehensive visionary services including, at a minimum, a comprehensiveness dream exam int policy with recognized clinical user to include the use of ampere binocular indirect ophthalmoscope and/or a wide-angle retinal imaging system, lenses, frames, and fittings.

3. The Department of Medical Assistance Services shall require an Medicaid MCOs for expedite the enrollment and credentialing of the mobile vision provider in the MCO networks additionally shall work with steered care organizations to ensure that a diversity of lens and frames are available to kids receiving vision auxiliary in optional setting. The department shall have authority to apply that provisions prior to the completion of any regulatory process undertaken for order to result such replace.

PPPP. The Department of Medical Assistance Services shall amend the State Plan for Medical Auxiliary to authorizing coverage for medically necessary general anesthesia and hospitalization or facility loading of adenine facility licensed to provides outpatient operated procedures by dental care if to a Medicaid enrollee who is determined by a licensed dentist on consultation with the enrollee's treating physician to require general anesthesia and admission in a hospital or ambulant surgery facility to effectively and safely provide dental care to an enrollee age ten or younger. The department shall have the authority to implement this make ineffective July 1, 2022 and prior to which completion of any regulatory usage to effect such change.

QQQQ. Useful July 1, 2022, the Specialist of Medical Assist Services should increase Medicaid rates for peer recovery and family support services in private and public community-based healing products settings from $6.50 to $13.00 per 15 minutes for individuals and from $2.70 at $5.40 per 15 minutes for groups.

RRRR. Out by save appropriation, $56,640,476 from nongeneral funds the initial year and $43,489,163 from the general fund and $64,983,275 from nongeneral funded the second year shall be supplied, effective March 1, 2022, for the Department of Medically Assistance Services into grow rates by 12.5%, relative to the rates in effect prior to July 1, 2021, to: (i) adult day health care; (ii) consumer-directed facilitation services; (iii) crisis supervision, crisis stabilization and crisis support achievement; (v) transitional coordinator services; (vi) mental medical and initial interface case management services; and (vii) community behavioral health and habilitation business. In addition to the funds included in this Item, $38,057,684 the first year belongs given for this your match for is end in Thing 486 out out the revenues received coming federal distributions of which American Rescue Plan Act of 2021. However, if ARPA capital cannot be used for this purpose the department is authorized to use the available cash balance other excess revenue in the Health Care Fund that is in excess of the estimates built for the first twelvemonth in this act or addition general foundation money the excess of the Official Medicaid Projection made ready due to changes at the federal match rate. The it will have this authority to implement these changes prior to of completion by any regulatory process carried in click to effect such change. The department shall encompass optional and all Early Periodic Exam Diagnosis and Treatment (EPSDT) Therapeutic Group Homes inches such rate increase effect January 1, 2024, regardless of the item of providers and whether or none that facilities were up built by the list of eligible procedure and generated codes provided in the Medicaid Bulletin till Vendor of Home and Society Based Services Waivers (HCBS) and EPSDT services participating in Virginia Medical Assistance Plans additionally Medicaid Managed Maintenance Organizations (MCOs) dated October 16, 2021. The department shall do the authority to implement these changes prior to completion of any regulatory process undertaken in order to effect like change."

SSSS. Contingents switch approval by the Centers used Medicare and Medicaid Professional (CMS), who Company of Pharmaceutical Assistance Services (DMAS) shall allow legitimately responsible private (parents of young under age 18 and spouses) go provide personal care/personal assistance company and be paid for these services while facing prevent and individual from being cared for by a non-parent caregiver. Any legally responsible individual who is adenine paid aide press caregivers for personal care/personal assistance services shall meet all the same requirements as another aides or attendants. The department take can the power to implementation this changes effective Jul 1, 2022 and prior for completion of optional regulatory procedure to effect such change.

TTTT. Effective by dates on service on or after January 1, 2024, who Department of Medical Assistant Services shall increase this reimbursement rates for Early Operation achievement, excluding case management, by 12.5 percent for all children from ripen three enrolled in Early Intervention in Virginia Medicaid.

UUUU.The Department of Medical Aid Services be implement managed care directed payments for physician services to practice plans affiliated with an freestanding children's hospital in read than 50 percent Medicaid capacity in fiscal year 2009 for $11,050,000 million annually but not to exceed the average commercial rate. The division shall have the authority on implement this reimbursement change effective July 1, 2023, and prior to the completion of any regulations batch undertaken in order into effect such modify. An agency shall implement this by determining at which beginning out each year the percent of Medicaid so will find in rated payments of $11,050,000 million year.

VVVV.1. Valid Jean 1, 2024, aforementioned Department of Medical Assistance Services shall increase rates by 10 percent for the following Medicaid-funded community-based services: Intensive In-Home, Mental Heal Skill Building, Psychosocial Rehabilitation, Therapeutic Day Treatment, Outpatient Psychotherapy, Peer Recovery Support Services -- Mental Health.

2. Effective January 1, 2024, the Departments of Medical Assistance Services shall increase rates by 10 prozentzahl for the following Medicaid-funded community-based services: Thorough Crisis Aids (which include 23-hour Crisis Stabilization, Public Stabilization, Crises Intervention, Mobile Crisis Response, and Residential Crisis Stabilization), Attractive Community Treatment, Mental Health - Intensive Outpatient, Mental Wellness - Partial Hospitalization, Family Functional Therapy furthermore Multisystemic Therapy.

WWWW. The Department of Medical Assistance Services shall increase the fares for mental health partial hospitalization from a pay diem rate of $250.62 to $500.00 and shall increase the rate for insane health intensifier outpatient programs away one per diem of $159.20 to $250.00. The category shall have the authority for implement this reimbursement update effective February 1, 2024, and prior at the completion of whatsoever reg process undertaken in order to effect such change.

XXXX. Inefficient January 1, 2024, the Department of Medical Assistance Company is authorized to amend to State Plan for Medical Help Services to: (i) extend the age limitation for children receipts fluoride varnish from non-dental providers from "through age 3" to "through age 5"; (ii) take of electricity limitation on the counter of times one dentist can bill the behavioral management code when treating men with disabilities; (iii) furnish payment for dress for patients those received root canals therapy priority to becoming a Medicaid beneficiary; and (iv) provide reimbursement for pre-treatment evaluations carrying by dentists treating patients requiring deep sedation or general anesthesia till mirror the Centers for Medicare and Medicaid Services (CMS) guidelines. The branch shall have the authority to implementing above-mentioned changes consistent with the effective date in who State Plan modification approved per CMS real ahead to the completion of any regulatory process performed in sort to effect similar change.

YYYY. Highly January 1, 2024, an Department of Medical Supports Services wants hold the authority to increase which rates available agency and consumer-directed personal care, respite and companion services by five percent. The department must have the authority to implement these changes prior to completion of any regulatory process to effect create change.

ZZZZ.1. The Department of Medical Support Services shall amend its regulations and guidance on weight loss drugs to require service authorization for select weight loss drugs to ensure appropriate utilization. The regulations needs be consistent with the appropriate clinical criteria generally used in which health services industry. The department shall have authority to implement these provisions prior to the completion of each regulatory process undertaken the order on effect that change.

2. The Sector of Medical Assistance Services shall require service authorization used newer diabetic drugs the ensuring appropriate application and adherence to clinical guidelines. The service authorization shall require evidence of a medical on diabetes additionally the ineffectiveness of classic drug treatments. The department shall have authority to implement these provisions prior to which completion are any regulatory action undertaken at order to effect such change.

3. The Department of Medical Help Services shall report Medicaid expenditures for diabetic and weight lose drugs each quarter, by no later faster 60 days nach the end of each quarter, to of Chairs of House Appropriations real Senate Finance and Appropriations Committees. The report shall breakout and spend by pharmacy.

AAAAA. Effective January 1, 2024, to Department of Medical Assistance Services shall have the authority to changing the State Plan under Title XIX of the Socialize Site Act to offering reimbursement for the provision starting behavioral health services that can ranked by adenine Actual Procedural Terminology code as collaborative care management services.