2021 Session

Budget Amendments - SB1100 (Member Request)

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Chief Patron: Deeds
Co-Patron(s): Hanger
Emergency Room Utilization Program

Item 303 #2s

Item 303 #2s

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

Page 336, line 19, strike "$21,849,583" and insert "$24,849,583".

Page 340, after line 32, insert:

"X. Out of this appropriation, $3,000,000 from the general fund the second year is provided for the Virginia Department of Health to contract with a vendor to develop a program to reduce the over utilization of hospital emergency departments by Medicaid members.  The department shall work with the Department of Medical Assistance Services, Medicaid managed care organizations, the Virginia Hospital and Healthcare Association (VHHA), the Medical Society of Virginia, the Department of Behavioral Health and Developmental Services, and the Virginia Association of Community Services Boards 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."  


(This amendment adds funding and language for the Virginia Department of Health 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 (more than 10 visits a year) with complex care needs. The upfront cost of $3.0 million from the general fund 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 existing program, (iv) community multi-disciplinary team development, and (v) community controlled substance monitoring. This amendment establishes a replacement program for the emergency room utilization program, that reduces provider fees, that was adopted by the 2020 General Assembly as a means of avoiding inappropriate emergency room costs in the Medicaid program. A separate amendment in the Department of Medical Assistance Services eliminates that program.)