2016 Session

Budget Amendments - SB30 (Committee Approved)

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Fund Enhanced Reimbursement for Nursing Homes with Specialized Populations

Item 306 #10s

Item 306 #10s

First Year - FY2017 Second Year - FY2018
Health and Human Resources
Department of Medical Assistance Services FY2017 $0 FY2018 $500,000 GF
FY2017 $0 FY2018 $500,000 NGF

Page 250, line 34, strike "$11,552,255,000" and insert "$11,553,255,000".

Page 265, after line 15, insert:

"7.  Effective July 1, 2017, 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 62.5 percent of the peer group day-weighted median neutralized and inflated cost per day for freestanding nursing facilities.  The adjustment factors shall increase to 75 percent on July 1, 2018 and to 85 percent on July 1, 2019.  The department shall have authority to promulgate emergency regulations to implement this amendment within 280 days or less from the enactment date of this act."


(This amendment provides $500,000 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 significantly longer stay in a nursing facility than many nursing facility 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.)