2014 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: O'Bannon
Sustain Medicaid Rates to Physicians at Medicare Level

Item 301 #30h

Item 301 #30h

First Year - FY2015 Second Year - FY2016
Health and Human Resources
Medical Assistance Services, Department of FY2015 $18,850,000 FY2016 $37,700,000 GF
FY2015 $18,850,000 FY2016 $37,700,000 NGF

Page 245, line 42, strike "$8,495,724,272" and insert "$8,533,424,272".
Page 245, line 42, strike "$8,761,183,102" and insert "$8,836,583,102".
Page 256, line 32, after "shall" insert "initially".
Page 256, line 35, before the period, insert "during this period."
Page 256, after line 39, insert:
"In order to support Medicaid reforms underway pursuant to paragraph TTT of this item, the department is directed to continue this primary care service payment policy for eligible providers contingent on such providers meeting certain criteria including:  (i) serving Medicaid recipients by performing at least a minimum number of Medicaid primary care services a year (as determined by the department in conjunction with contracting managed care plans); and (ii) participating in payment and delivery reforms tied to achieving specific care coordination, quality, and health improvement goals for Medicaid recipients, such as being part of an National Committee for Quality Assurance (NCQA)-certified medical home, an approved Accountable Care Organization (ACO), or participation in a Virginia Medicaid managed care health plan with incentives tied to similar goals.  The Department of Medical Assistance Services, in partnership with the Virginia Center for Health Innovation, will develop the specific requirements and mechanisms for certifying adherence to these criteria, including potential exceptions for these requirements in those circumstances where practices demonstrating active participation in Medicaid would be unable to comply due to reasons such as practice size, technology limitations or non-availability of primary care medical home or ACO type models or Medicaid managed care programs."

(This amendment provides funding to sustain the current reimbursement rates for primary care services under Medicaid at Medicare levels. This provision of the Affordable Care Act expires on December 31, 2014. Proposed budget language requires that certain conditions be met to receive reimbursement at Medicare levels for primary care services including that providers would be required to participate in Medicaid reforms and care coordination innovations designed to improve quality and lower costs. Preserving access to primary care services for Medicaid recipients is foundation to many of the Medicaid care management reforms currently underway.)