2021 Session

Budget Amendments - HB1800 (Member Request)

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Chief Patron: Sickles
Emergency Room Utilization Program

Item 313 #9h

Item 313 #9h

First Year - FY2021 Second Year - FY2022
Health and Human Resources
Department of Medical Assistance Services FY2021 $0 FY2022 $3,000,000 GF
FY2021 $0 FY2022 $3,000,000 NGF

Page 345, line 39, strike "$17,494,923,315" and insert "$17,500,923,315".

Page 382, after line 17, insert:

"AAAAAA.  Out of this appropriation, $3,000,000 from the general fund the second year and $3,000,000 from nongeneral funds is provided to develop a program to reduce the over utilization of hospital emergency departments by Medicaid members.  The Department of Medical Assistance Services shall work with the Medicaid managed care organizations, the Virginia Hospital and Healthcare Association (VHHA), the Medical Society of Virginia, the Department of Behavioral Health and Developmental Services, the Virginia Association of Community Services Boards, and the Virginia Department of Health (VDH) to develop the parameters for the program including how to identify appropriate candidates for the program, coordination of case management, interventions and community services to prevent avoidable emergency room visits and the use of multi-disciplinary teams to work with Medicaid patients with complex care needs. The department shall determine what existing resources could be used to facilitate the development of the program.  The department shall have the authority to implement such changes to the Medicaid  program as may be necessary to implement this program and the authority to promulgate emergency regulations prior to the completion of any regulatory process undertaken in order to effect such changes."  


(This amendment adds funding and language for the Department of Medical Assistance Services to develop a program to prevent the inappropriate over utilization of hospital emergency departments(EDs) by Medicaid members. This program would identify Medicaid members who are high utilizers of ED services with complex care needs. The upfront cost of $3.0 million from the general fund and $3.0 million from nongeneral funds would be used to set up and staff five teams across the commonwealth, each responsible for managing a certain number of the estimated 1,500 enrollees per year, which could result in state savings of approximately $36.0 million per year. A contractor could be used to coordinate efforts with payers and existing community resources, such as the new VDH/VHHA partnership with Unite US, a resource tool, with a focus on the following five areas of proven success with complex cases: (i) direct patient engagement, (ii) community resource coordination, partnering with Unite Us, (iii) customized care plan development using the current EDIE program, (iv) community multi-disciplinary team development, and (v) community controlled substance monitoring.)