2010 Session

Budget Amendments - SB30 (Committee Approved)

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Reciprocal Payments for Out-of-State Hospitals

Item 297 #6s

Item 297 #6s

First Year - FY2011 Second Year - FY2012
Health And Human Resources
Medical Assistance Services, Department of FY2011 ($2,253,621) FY2012 ($2,965,290) GF
FY2011 ($3,676,959) FY2012 ($2,965,290) NGF

Page 196, line 50, strike "$6,806,326,159" and insert "$6,800,395,579".
Page 196, line 50, strike "$7,272,405,030" and insert "$7,266,474,450".
Page 209, after line 23, insert:
"XXX.  Effective July 1, 2010, the Department of Medical Assistance Services shall amend the State Plan for Medical Assistance to pay out-of-state border hospitals who treat Virginia Medicaid recipients at inpatient operating rates that are a percentage of reimbursement they would otherwise be paid based on the percentage of reimbursement their state Medicaid program, on average, pays similarly situated Virginia hospitals for treating their Medicaid recipients.  The department shall determine the percentage of reimbursement that border state Medicaid programs, on average, pay similarly situated Virginia hospitals for treating their Medicaid recipients up to 100 percent and include those percentages in regulation.  Out-of-state cost reporting hospitals who have Virginia Medicaid utilization in the base year of at least 12 percent of total Medicaid days shall continue to be paid as similarly situated Virginia hospitals are for operating payments. The department shall promulgate regulations to become effective within 280 days or less from the enactment of the Act."

(This amendment reduces payments to out-of-state hospitals treating Virginia Medicaid recipients by reimbursing these hospitals at the same rate their states pay Virginia hospitals for serving children from that state. Hospitals whose Virginia Medicaid days make up 12 percent or more of their total Medicaid days are not subject to the reduction.)