2016 Session

Budget Amendments - HB30 (Committee Approved)

View Budget Item
View Budget Item amendments

Increase Payment Rate by 15% for Nursing Homes with Special Populations

Item 306 #6h

Item 306 #6h

First Year - FY2017 Second Year - FY2018
Health and Human Resources
Department of Medical Assistance Services FY2017 $619,511 FY2018 $619,511 GF
FY2017 $619,511 FY2018 $619,511 NGF

Page 250, line 34, strike "$9,740,405,698" and insert "$9,741,644,720".
Page 250, line 34, strike "$11,552,255,000" and insert "$11,553,494,022".

Page 265, after line 15, insert:

"7. The department shall amend the State Plan for Medical Assistance to increase the direct operating rate under the nursing facility price based reimbursement methodology by 15% for nursing facilities where at least 80% of the resident population have one or more of the following diagnoses: quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy.  In addition, a qualifying facility must have at least 90% Medicaid utilization and a case mix index of 1.15 or higher in fiscal year 2014.  The department shall have the authority to implement this reimbursement methodology change for rates on or after July 1, 2016, and prior to completion of any regulatory process in order to effect such change."


(This amendment adds funding and language to change the reimbursement methodology for nursing facilities that provide services to a resident population in which at least 80 percent of the residents have specific chronic and disabling conditions and the facility has at least a 90% Medicaid utilization and a case mix index of 1.15 or higher in fiscal year 2017. These conditions tend to occur in a younger population who consequently have a significant longer stay in a nursing facility than many nursing home residents. Consequently, the costs to serve these individuals is much higher. Currently, only one nursing facility, the Virginia Home, would meet the criteria to qualify for additional funding pursuant to the reimbursement methodology change.)