2016 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: Loupassi
Co-Patron(s): Carr, Farrell, Garrett, Ingram, Lingamfelter, O'Bannon, Peace, Robinson, Sickles, Stolle
Change Reimbursement Method for Nursing Homes with Special Populations

Item 306 #5h

Item 306 #5h

First Year - FY2017 Second Year - FY2018
Health and Human Resources
Department of Medical Assistance Services FY2017 $0 FY2018 $2,930,950 GF
FY2017 $0 FY2018 $2,930,950 NGF

Page 250, line 34, strike "$11,552,255,000" and insert "$11,558,116,900".

Page 265, after line 15, insert:

"7.  The department shall amend the State Plan for Medical Assistance to create a separate peer group for both direct and indirect care for nursing facilities that provide services to a resident population where a disproportionate number of residents, defined as at least 80 percent of the total Medicaid resident population, have one or more of the following diagnoses:  quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy.  The adjustment factors used to determine both the direct and indirect care costs for these new peer groups shall be established at 100 percent of the peer group day-weighted median neutralized and inflated cost per day for freestanding nursing facilities.  The department shall have the authority to implement this reimbursement methodology change for rates effective on and after July 1, 2017, and prior to completion of any regulatory process in order to effect such change."


(This amendment provides $2.9 million from the general fund the second year and a like amount of federal Medicaid matching funds 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. 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.)