1998 Session

Budget Amendments - HB30 (Conference Report)

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DMAS Emergency Regulations (language only)

Item 335 #20c

Item 335 #20c

Health And Human Resources
Medical Assistance Services, Department of

Page 218, after line 3, insert:
"Q.  Effective July 1, 1998, the Board of Medical Assistance Services shall promulgate emergency regulations necessary to implement a fully prospective reimbursement system for hospital inpatient services.  These emergency regulations are to remain effective until such time as they are superseded by permanent regulations duly promulgated under the authority of the Code of Virginia, § 9-6.14:7.1 et seq.  Reimbursement rates for most inpatient services shall be based on Diagnosis Related Groups (DRG) methodology.  The Board shall also promulgate emergency regulations necessary to implement utilization control measures (prior authorization and utilization control) so as to make them consistent with the prospective DRG reimbursement methodology.  The emergency regulations shall include, but not be limited to, provisions that (i) eliminate the 21-day cap on length of stay for adults for those services to be governed under a prospective, case-based payment methodology, and (ii) recalibrate (evaluate and adjust the weights assigned to cases) and rebase (review and update as appropriate the cost basis on which the base rate is developed) the DRG system at least every other year.  As the Department develops regulations to implement the new reimbursement methodology, the Department shall consult with affected provider groups."

(This amendment authorizes the Department of Medical Assistance Services to promulgate emergency regulations for reimbursement of hospital inpatient services).