2019 Session

Budget Amendments - SB1100 (Member Request)

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Chief Patron: Newman
Funding for Mandatory All Payer Claims Database

Item 307 #1s

Item 307 #1s

First Year - FY2019 Second Year - FY2020
Health and Human Resources
Department of Medical Assistance Services FY2019 $0 FY2020 $87,500 GF
FY2019 $0 FY2020 $262,500 NGF

Page 343, line 28, strike "$291,221,330" and insert "$291,571,330".

Page 350, after line 9, insert:

"Y.  Out of this appropriation, $87,500 from the general fund and $262,500 from nongeneral funds the second year, shall be provided for support of the All Payer Claims Database operated by Virginia Health Information.  This appropriation is contingent on federal approval of an Operational Advanced Planning Document."


(This amendment provides $87,500 from the general fund and $262,500 from federal Medicaid matching funds to support the All Payer Claims Database (APCD). Senate Bill 1216 would make participation in the APCD mandatory. This amendment allows the Department of Medical Assistance Services (DMAS) to access enhanced federal funding to support its use of the APCD. Virginia's APCD has been operational for four years. Virginia Health Information (VHI) collects paid claims data from all health insurers operating in the Commonwealth, including the Medicaid program operated by DMAS and federal health insurance programs (including TRICARE and Medicare). The data is used for a variety of purposes including improving public health surveillance and population health, comparing the quality and efficiency of health care, and designing and evaluating alternative delivery and payment models. As required by statute (Code of Virginia, Section 32.1- 276.7:1), DMAS regularly shares paid claims data for its members, and its contracted managed care organizations (MCOs) also regularly share data with VHI for the Medicaid members they serve. VHI contains claims data for around 4.4 million individuals, and 25 percent of those individuals are Medicaid members. In addition to providing data, DMAS regularly uses VHI data for analyses. Medicaid can use enhanced federal funding at a 75 percent federal matching rate to support the maintenance and operations of the APCD. At least seven other states (Oregon, Florida, New York, Colorado, Rhode Island, Utah and New Hampshire) currently pay for a portion of the maintenance and operations of their APCD using Medicaid enhanced federal funding. Furthermore, the Centers for Medicare and Medicaid Services (CMS) has confirmed that this type of funding can be available to Virginia's APCD if DMAS submits and CMS approves an Operational Advanced Planning Document (O-APD) for the project and payments. This budget amendment seeks $350,000 total funds for payments to VHI to support the day-to-day operations of the APCD. This amount is proportional to the volume of APCD claims that are associated with Virginia Medicaid members.)