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2018 Session

Budget Amendments - SB30 (Floor Approved)

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Supplemental Funding for UVA Medical Center and VCU Health System

Item 303 #10s

Item 303 #10s

First Year - FY2019 Second Year - FY2020
Procedures for Prepayment of Civil Penalties in an Executive Order
Department of Medical Assistance Services FY2019 $10,100,000 FY2020 $10,500,000 NGF

Language
Page 257, line 34, strike "$10,983,034,643" and insert "$10,993,134,643".
Page 257, line 34, strike "$12,657,131,076" and insert "$12,667,631,076".

Page 271, line 41, after "XX.1." insert "a.".

Page 272, after line 10, insert:

"b. The department shall adjust capitation payments to Medicaid managed care organizations for the purpose of securing access to Medicaid hospital services for the qualifying private hospital partners of Type One hospitals (consisting of state-owned teaching hospitals).  The department shall revise its contracts with managed care organizations to incorporate these supplemental capitation payments, and provider payment requirements. DMAS shall enter into a transfer agreement with any Type One hospital whose private hospital partner qualifies for such supplemental payments, under which the Type One hospital shall provide the state share in order to match federal Medicaid funds for the supplemental payments to the private hospital partner. The department shall have the authority to implement these reimbursement changes consistent with the effective date approved by the Centers for Medicare and Medicaid Services (CMS). No payment shall be made without approval from CMS."

Page 273, after line 36, insert:

"7.a.  There is hereby appropriated a sum-sufficient nongeneral funds for the department to pay the state share of supplemental payments for nursing homes owned by Type One hospitals (consisting of state-owned teaching hospitals) as provided in the State Plan for Medical Assistance Services.  The total supplemental payment shall be based on the difference between the Upper Payment Limit of 42 CFR § 447.272 as approved by CMS and all other Medicaid payments subject to such limit made to such nursing homes. DMAS shall enter into a transfer agreement with any Type One hospital whose nursing home qualifies for such supplemental payments, under which the Type One hospital shall provide the state share in order to match federal Medicaid funds for the supplemental payments.  The department shall have the authority to implement these reimbursement changes consistent with the effective date in the State Plan amendment approved by CMS and prior to completion of any regulatory process in order to effect such changes.

b.  The department shall adjust capitation payments to Medicaid managed care organizations to fund a minimum fee schedule compliant with requirements in 42 C.F.R. § 438.6(c)(1)(iii) at a level consistent with the State Plan amendment authorized above for nursing homes owned by Type One hospitals (consisting of state-owned teaching hospitals).  The department shall revise its contracts with managed care organizations to incorporate these supplemental capitation payments and provider payment requirements. DMAS shall enter into a transfer agreement with any Type One hospitals whose nursing home qualifies for such supplemental payments, under which the Type One hospital shall provide the state share in order to match federal Medicaid funds for the supplemental payments. The department shall have the authority to implement these reimbursement changes consistent with the effective date approved by CMS. No payment shall be made without approval from CMS."



Explanation

(This amendment provides an authority for the Commonwealth's two state teaching hospitals, VCU Health System and UVA Medical Center, to maintain federal supplemental funding by adapting the payment methodology to address the move of the state's Medicaid program from fee-for-service to a managed care delivery system. The teaching hospitals will provide the state share in order to match federal Medicaid funds, such that no general fund expenditure is needed.)